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neelkanthhospital-blog · 3 years

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What are gallstones and laparoscopic cholecystectomy treatments in Gurgaon?

Gallstones are formed from bile, a material that aids in fat digestion and vitamin absorption. The liver produces bile, which is then transported to the gallbladder, a thin, pear-shaped organ that concentrates and stores it. Food fat induces the release of a hormone, which causes the gallbladder to contract and release bile into the intestine. Call us and schedule your appointment for laparoscopic cholecystectomy treatment in Gurgaon at Neelkanth hospital. Gallstones are solid lumps formed when stored bile crystallizes. Most are less than an inch in diameter, but they can range in size from a grain of sand to a golf ball. The majority of gallstones are made up mostly of cholesterol. The remainder, known as pigment stones, are composed of calcium salts and bilirubin, a byproduct of red blood cell breakdown. Cholesterol stones develop when the gallbladder's liquid bile contains more cholesterol than the bile salts can remove. Cholesterol stones may form if the gallbladder does not contract and empty properly. Pigment stones are linked to a variety of medical conditions, including liver disease, anemia, and bile duct infection.

Why are women at greater risk? It's a product of female hormones. Estrogen raises cholesterol levels in bile, while progesterone delays gallbladder emptying. This could explain why, in comparison to men, the risk for women decreases with age. Women are diagnosed with gallstones almost three times more often than men by the age of 40 (pregnancy, for example, raises the risk), but by the age of 60, their risk is only marginally higher. Estrogen therapy raises the risk, especially when administered as a pill rather than a patch. Oral contraceptives raise the risk marginally as well, but only in the first decade of use. Obesity is another risk factor because fat bodies contain more estrogen. Rapid weight loss, on the other hand, raises the risk that very low-calorie diets interfere with bile development, causing further cholesterol crystallization. Gallstones are so prevalent after weight-loss surgery that patients are often recommended to have their gallbladders removed as well. Gallstones are also more common in people who have diabetes or another disease that impairs gallbladder contractions or intestinal motility, such as a spinal cord injury. Finally, there is some evidence of a hereditary predisposition to gallstone formation. Book your appointment with the best hospital for laparoscopic cholecystectomy treatment in Gurgaon.

What are the signs and symptoms? The majority of people who have gallstones are unaware of their condition. Their gallstones remain silent and can only be detected by chance, such as through an ultrasound or CT scan is done for another cause. Symptoms occur mostly when stones move into or block a bile duct, resulting in biliary colic, also known as a gallbladder assault. These attacks occur when the gallbladder contracts (usually in reaction to a fatty meal) and forces the stones against the gallbladder duct, causing it to become blocked. The main symptom is pain, which normally occurs in the right upper or middle abdomen (just below the rib cage), and which increases in severity within an hour and can last for several hours. It can be painful and knifelike or a deep ache, and it can radiate to the back or right shoulder. Nausea and vomiting are also possible. When the gallbladder relaxes, the pain subsides. A stone stuck in a duct may also cause more severe complications, such as acute cholecystitis (gallbladder inflammation), pancreatitis (pancreas inflammation), or cholangitis (inflammation of the bile ducts in the liver). Any of these conditions can result in excruciating pain and other symptoms such as jaundice, high fever, chills, and vomiting. In most cases, treatment entails intravenous antibiotics and, in some cases, surgical removal of the stone. If you believe you are having a gallbladder attack, your doctor will most likely prescribe some blood tests as well as an abdominal ultrasound (after you fast for at least eight hours). Ultrasound is particularly useful in diagnosing acute cholecystitis since it detects gallbladder wall thickening and signals the presence of fluid, which may indicate inflammation. Other diagnostic techniques include cholescintigraphy, which uses a radioactive injection to see whether the cystic duct is blocked; magnetic resonance imaging (MRI) of the bile ducts; endoscopic ultrasonography, which inserts an ultrasound device through the mouth, esophagus, and stomach to the duodenum (the first section of the small intestine) to obtain images of the area.

What is the treatment for gallstones? Gallstones can only be treated if they are causing symptoms. The most common cure for recurring gallbladder attacks is the surgical removal of the gallbladder, also known as cholecystectomy. Previously, the normal treatment required a five-inch incision and a hospital stay of up to a week. Laparoscopic cholecystectomy, in which the gallbladder is removed using instruments inserted through tiny incisions in the skin, has mostly replaced this approach. This treatment only necessitates an overnight hospital stay and a week of recuperation at home. However, there is a small risk of damaging the bile ducts, and complications may force the surgeon to turn to open surgery with a larger incision in 5% to 10% of cases. You should get by without a gallbladder. Bile is produced by the liver in sufficient quantities to allow for normal digestion. When the gallbladder is removed, the bile simply flows into the small intestine through the normal bile duct. Loose stools can occur when there is no food present, but this can be treated with a bile acid–binding drug, such as cholestyramine.

How can I lower my chances of developing gallstones? There is no proven method for preventing gallstones, although research does point to several possibilities. Consume three well-balanced meals a day, maintain a healthy weight, and engage in frequent physical activity (at least 30 minutes a day most days of the week). Several studies have shown that mild alcohol intake is associated with a lower risk of symptom-causing gallstones. The Nurses' Health Study also discovered that women who consumed more fiber and ate multiple 1-ounce servings of nuts each week were less likely to require gallbladder surgery. While avoiding fatty foods may not prevent or cure gallstones, it can reduce the frequency of attacks. Schedule your appointment and get the affordable cost of laparoscopic cholecystectomy treatment in Gurgaon.

#cost of laparoscopic cholecystectomy treatment in Gurgaon.#best hospital for laparoscopic cholecystectomy treatment in Gurgaon #laparoscopic cholecystectomy treatment in Gurgaon

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siva3155 · 5 years

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300+ TOP HERNIA & ACUTE ABDOMEN Objective Questions and Answers

HERNIA and ACUTE ABDOMEN Multiple Choice Questions :-

1. The most common hernia in females is: A. Femoral hernia. B. Direct inguinal hernia. C. Indirect inguinal hernia. D. Obturator hernia. E. Umbilical hernia. Answer: C 2. Which of the following statements regarding unusual hernias is incorrect? A. An obturator hernia may produce nerve compression diagnosed by a positive Howship-Romberg sign. B. Grynfeltt's hernia appears through the superior lumbar triangle, whereas Petit's hernia occurs through the inferior lumbar triangle. C. Sciatic hernias usually present with a painful groin mass below the inguinal ligament. D. Littre's hernia is defined by a Meckel's diverticulum presenting as the sole component of the hernia sac. E. Richter's hernia involves the antimesenteric surface of the intestine within the hernia sac and may present with partial intestinal obstruction. Answer: C 3. Staples may safely be placed during laparoscopic hernia repair in each of the following structures except: A. Cooper's ligament. B. Tissues superior to the lateral iliopubic tract. C. The transversus abdominis aponeurotic arch. D. Tissues inferior to the lateral iliopubic tract. E. The iliopubic tract at its insertion onto Cooper's ligament. Answer: D 4. The following Nyhus classification of hernias is correct except for: A. Recurrent direct inguinal hernia—Type IVa. B. Indirect inguinal hernia with a normal internal inguinal ring—Type I. C. Femoral hernia—Type IIIc. D. Direct inguinal hernia—Type IIIa. E. Indirect inguinal hernia with destruction of the transversalis fascia of Hesselbach's triangle—Type II. Answer: E 5. Which of the following statements about the causes of inguinal hernia is correct? A. Excessive hydroxyproline has been demonstrated in the aponeuroses of hernia patients. B. Obliteration of the processus vaginalis is a contributing factor for the development of an indirect inguinal hernia. C. Physical activity and athletics have been shown to have a protective effect toward the development of inguinal hernias. D. Elevated levels of circulating serum elastalytic activity have been demonstrated in patients with direct herniation who smoke. E. The majority of inguinal hernias are acquired. Answer: D 6. The following statements about the repair of inguinal hernias are true except: A. The conjoined tendon is sutured to Cooper's ligament in the Bassini hernia repair. B. The McVay repair is a suitable option for the repair of femoral hernias. C. The Shouldice repair involves a multilayer, imbricated repair of the floor of the inguinal canal. D. The Lichtenstein repair is accomplished by prosthetic mesh repair of the inguinal canal floor in a tension-free manner. E. The laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal approach (TEPA) repairs are based on the preperitoneal repairs of Cheattle, Henry, Nyhus, and Stoppa. Answer: A 7. Which of the following statements concerning the abdominal wall layers are correct? A. Scarpa's fascia affords little strength in wound closure. B. The internal abdominal oblique muscles have fibers that continue into the scrotum as cremasteric muscles. C. The transversalis fascia is the most important layer of the abdominal wall in preventing hernias. D. The lymphatics of the abdominal wall drain into the ipsilateral axillary lymph nodes above the umbilicus and into the ipsilateral superficial inguinal lymph nodes below the umbilicus. Answer: ABCD 8. Which of the following congenital abnormalities are correctly defined? A. Omphalocele represents a defect in the abdominal wall lateral to the umbilical cord. B. The herniated viscera associated with omphaloceles are usually covered with a membranous sac. C. An umbilical polyp is a small excrescence of omphalomesenteric duct mucosa that is retained in the umbilicus. D. Meckel's diverticulum results when the intestinal end of the omphalomesenteric duct persists and represents a true diverticulum. Answer: BCD 9. The following statement(s) is/are true concerning the indications for treatment of an inguinal hernia. a. Most adult hernias will remain stable in size, therefore delay seldom affects the technical aspects of a surgical repair b. There is a direct correlation between the length of time that a hernia is present and the risk of major complications c. The morbidity and mortality associated with emergent operation due to hernia complications is significantly greater than for elective repair of the identical hernia d. A truss maintains a hernia in the reduced state, therefore, minimizing the risk of incarceration and strangulation Answer: b, c 10. Which of the following statement(s) is/are true concerning the diagnosis and management of epigastric hernias? a. A large peritoneal sac containing abdominal viscera is common b. At the time of surgical repair, a careful search for other defects should be performed c. Recurrent epigastric hernias after simple closure is uncommon d. Patients with symptoms of a painful midline abdominal mass frequently will contain incarcerated small bowel Answer: b

HERNIA & ACUTE ABDOMEN MCQs 11. The following statement(s) is/are true concerning neurovascular structures in the inguinal region. a. The inferior epigastric artery and vein run upward in the preperitoneal fat posterior to the transversalis fascia close to the lateral margin of the internal inguinal ring b. The iliohypogastric and ilioinguinal are motor and sensory nerves in the inguinal region which lie beneath the external oblique aponeurosis c. The ilioinguinal nerve runs anterior to the spermatic cord in the inguinal canal and at the superficial inguinal ring, branches into the sensory supply to the pubic region and the upper scrotum or labium majoris d. The genital branch of the genitofemoral nerve is a sensory nerve only to the upper thigh and genital area Answer: b, c 12. In advising a patient preoperatively of potential complications of operative treatment of an inguinal hernia, which of the following statement(s) is/are true? a. Severe symptoms due to sensory nerve entrapment or injury can occur b. The most common vascular structure injured during the course of a groin hernia repair is the femoral artery c. Recurrent hernia after primary groin repair should occur in less than 10% of cases d. Wound infection increases the risk of recurrent hernia Answer: a, c, d 13. Chylous ascites is the accumulation of chyle within the peritoneal cavity. Which of the following statement(s) is/are true concerning chylous ascites? a. The cisterna chyli lies at the anterior surface of the first and second lumbar vertebrae and receives lymphatic fluid from the mesenteric lymphatics b. Chylous ascites is most commonly associated with abdominal lymphoma c. Paracentesis and analysis of chylous fluid typically reveals elevated triglycerides, protein, and leukocyte levels with cytologic analysis reflecting the underlying presence of malignancy d. Treatment of chylous ascites with dietary manipulation will be successful in most cases e. The mortality rate in adults with chylous ascites is in excess of 50% Answer: a, b, e 14. Which of the statement(s) is/are true concerning laparoscopic hernia repair? a. General anesthesia is required b. Either an abdominal or preperitoneal approach is possible c. The use of prosthetic mesh is required in all variations d. Long-term results suggest that the laparoscopic approach is equal or better than traditional repairs Answer: a, b, c 15. A 28-year-old woman with a history of an appendectomy presents with a nontender palpable mass in the right lower quadrant abdominal incision. The following statement(s) is/are true concerning the diagnosis and management of this patient. a. The best diagnostic test involves imaging of the abdominal wall by either CT or MRI b. Resection of the mass with a 2 cm margin is usually adequate c. Low dose radiation is a suitable alternative to surgery for primary treatment d. Re-resection for recurrence will likely have a higher rate of recurrence than for primary resection Answer: a 16. Which of the following statement(s) is/are true concerning repair of inguinal hernias? a. The Bassini repair approximates the transversus abdominis aponeurosis and transversalis fascia and the shelving edge of the inguinal ligament. b. The Bassini repair is an adequate repair for a femoral hernia c. A relaxing incision is important for repairs of direct and large indirect inguinal hernias to prevent excessive tension in the closure d. An advantage to the use of prosthetic material is the mesh incites formation of scar tissue to further increase tensile strength provided by the mesh alone Answer: a, c, d 17. The following statement(s) is/are true concerning the epidemiology of inguinal hernias. a. Inguinal hernias occur with a male-to-female ratio of about 7:1 b. Femoral and umbilical hernias are more common in women, with a female-to-male ratio of 4:1 c. The frequency of inguinal hernias increases with age d. Almost all umbilical hernias occur in the pediatric age group Answer: a, c 18. A 77-year-old multiparous female presents with a bowel obstruction. She has no previous abdominal operations and no abdominal wall hernias can be detected. In addition to her abdominal symptoms, she reports pain in her right medial thigh. The following statement(s) is/are true concerning her diagnosis and management. a. Expectant management with nasogastric suction and IV fluid replacement is indicated b. A right groin approach is indicated for exploration and repair of the presumed hernia c. The use of a polypropylene mesh will likely be necessary for repair d. A correct diagnosis can usually be made by visualizing an external mass in the upper, medial thigh Answer: c 19. The following statement(s) is/are true concerning umbilical hernias in adults. a. Most umbilical hernias in adults are the result of a congenital defect carried into adulthood b. A paraumbilical hernia typically occurs in multiparous females c. The presence of ascites is a contraindication to elective umbilical hernia repair. d. Incarceration is uncommon with umbilical hernias Answer: b 20. Retroperitoneal fibrosis is a fibrosing condition of retroperitoneum, which is of significance as it generally encompasses the ureters and eventually causes hydronephrosis and kidney damage. Which of the following statement(s) is/are true concerning this condition? a. The majority of cases are idiopathic in nature b. A history of use of methysergide for treatment of migraine headaches would be significant c. There is no known association of malignancy with retroperitoneal fibrosis d. The disease occurs more commonly in women than in men Answer: a, b 21. The following statement(s) is/are true concerning the anterior abdominal wall musculature. a. The lateral musculature of the abdominal wall consists of three muscle layers. These are, from external to internal, the external oblique, the transversus abdominis, and the internal oblique muscles b. The transversalis fascia lies on the deep side of the transversus muscle and extends to form an essentially complete fascial envelope of the abdominal cavity c. Above the semicircular line, the internal oblique aponeurosis splits into posterior and anterior laminae d. The rectus abdominis muscles originate on the ribs superiorly and on the pubis inferiorly and are clearly distinct throughout their entire length Answer: b, c 22. A 48-year-old woman maintained on Warfarin for a history of cardiac valvular replacement and a history of recent upper respiratory infection presents with severe abdominal pain exacerbated by movement. Her physical examination shows tenderness in the right paramedian area with voluntary guarding but no peritoneal signs. The following statement(s) is/are true concerning the diagnosis and management of this patient. a. Urgent laparotomy should be performed because of concern for arterial mesenteric embolus b. The correct diagnosis could likely be made by CT scan and operation avoided c. The status of her anticoagulation should be checked and if her prothrombin time is excessively prolonged, correction is necessary d. If untreated, hemodynamic instability is common Answer: b, c 23. True statements concerning the diagnosis and management of retroperitoneal fibrosis include: a. Most patients present with dull, non-colicky back, flank, or abdominal pain b. Evidence of impaired renal function with an elevated blood urea nitrogen is common c. The diagnosis is most commonly suggested by intravenous pyelography although contrast studies with CT scan or MRI are useful in further defining the disease d. Most patients can be managed nonoperatively e. The prognosis for nonmalignant retroperitoneal fibrosis is grim with progression of disease until death occurring in most patients Answer: a, b, c 24. The following statement(s) is/are true concerning incarceration of an inguinal hernia. a. All incarcerated hernias are surgical emergencies and require prompt surgical intervention b. Attempt at reduction of an incarcerated symptomatic hernia is generally considered safe c. Vigorous attempts at reduction of an incarcerated hernia may result in reduction en masse with continued entrapment and possible progression to obstruction or strangulation d. Incarcerated hernias frequently cause both small and large bowel obstruction Answer: b, c 25. A careful history is necessary in all patients being considered for inguinal hernia repair. Symptoms which deserve investigation and appropriate treatment prior to proceeding with inguinal hernia repair include: a. Chronic cough b. Urinary hesitancy and straining c. Change in bowel habit d. A specific episode of muscular straining with associated discomfort Answer: a, b, c HERNIA and ACUTE ABDOMEN Objective Type Questions with Answers 26. The following statement(s) is/are true concerning abdominal incisional hernias. a. Large incisional hernias are associated with a high recurrence rate when closed primarily b. A large potential space remains anterior to the abdominal wall closure in most patients indicating a need for postoperative wound drainage c. The use of prosthetic mesh can often be avoided by employing relaxing incisions in the anterior fascia parallel to the midline d. Incisional hernias are frequently associated with a tissue deficit either due to chronic retraction and scarring or the result of tissue necrosis from either infection or tension at the initial closure Answer: a, b, c, d 27. Which of the following structures are derived from the external oblique muscle and its aponeurosis? a. The inguinal or Poupart’s ligament b. The lacunar ligament c. The superficial inguinal ring d. The conjoined tendon Answer: a, b, c 28. A number of special circumstances exist in the repair of inguinal hernias. The following statement(s) is/are correct. a. Simultaneous repair of bilateral direct inguinal hernias can be performed with no significant increased risk of recurrence b. The preperitoneal approach may be appropriate for repair of a multiple recurrent hernia c. A femoral hernia repair can best be accomplished using a Bassini or Shouldice repair d. Management of an incarcerated inguinal hernia with obstruction is best approached via laparotomy incision Answer: b 29. Which of the following statements concerning intraperitoneal fluid collections are correct? A. Ascites occurs when either the peritoneal fluid secretion rate increases or the absorption rate decreases. B. Accumulation of lymph within the peritoneal cavity usually results from trauma as tumor involving the intra-abdominal lymphatic structures. C. Choleperitoneum (intraperitoneal bile) generally occurs following biliary surgery, but spontaneous perforation of the bile duct has been reported. D. The most common cause of hemoperitoneum is trauma to the liver or spleen. Answer: ABCD 30. The following statement about peritonitis are all true except: A. Peritonitis is defined as inflammation of the peritoneum. B. Most surgical peritonitis is secondary to bacterial contamination. C. Primary peritonitis has no documented source of contamination and is more common in adults than in children and in men than in women. D. Tuberculous peritonitis can present with or without ascites. Answer: C 31. True or false? A. Mesenteric cysts are most often due to congenital lymphatic spaces that gradually fill with lymph. B. Mesenteric cysts usually present as abdominal masses accompanied by pain, nausea, or vomiting. C. Mesenteric cysts are best treated by marsupialization. D. Omental cysts are frequently asymptomatic unless they undergo torsion. Answer: A-TRUE, B-TRUE, C-FALSE, D-TRUE 32. Which of the following statements about acute salpingitis are true? A. The disease rarely occurs after menopause. B. Gonococcal infection is most common. C. There is minimal cervical tenderness to palpation. D. Vaginal discharge occurs rarely. Answer: AB 33. Acute appendicitis is most commonly associated with which of the following signs? A. Temperature above 104؛ F. B. Frequent loose stools. C. Anorexia, abdominal pain, and right lower quadrant tenderness. D. White blood cell count greater than 20,000 per cu. mm. Answer: C 34. Which of the following most often initiates the development of acute appendicitis? A. A viral infection. B. Acute gastroenteritis. C. Obstruction of the appendiceal lumen. D. A primary clostridial infection. Answer: C 35. The diagnosis of acute appendicitis is most difficult to establish in: A. Persons aged 60 and older. B. Women aged 18 to 35. C. Infants younger than 1 year. D. Pregnant women. Answer: C 36. Once a diagnosis of acute appendicitis has been made and appendectomy decided upon, which of the following is/are true? A. Prophylactic antibiotics should be administered. B. Prophylactic antibitics are not necessary unless there is evidence of perforation. C. If the appendix is not ruptured and not gangrenous, antibiotics may be discontinued after 24 hours. D. Multiple antibiotics are in all cases preferable to a single agent. Answer: AC 37. The best type of x-ray to locate free abdominal air is: A. A posteroanterior view of the chest. B. A flat and upright view of the abdomen. C. Computed tomograph (CT) of the abdomen. D. A lateral decubitus x-ray, right side up. Answer: D 38. The most helpful diagnostic radiographic procedure in small bowel obstruction is: A. CT of the abdomen. B. Contrast study of the intestine. C. Supine and erect x-rays of the abdomen. D. Ultrasonography of the abdomen. Answer: C 39. The most commonly used imaging method for diagnosis of acute cholecystitis is: A. CT of the abdomen. B. Ultrasonography of the gallbladder. C. Oral cholecystogram. D. Radionuclide (HIDA) scan of the gallbladder. Answer: B 40. Acute salpingitis occurs most often: A. After menopause. B. In patients with unilateral lower abdominal pain. C. During the menstrual cycle. D. In patients with cervical tenderness and vaginal discharge. Answer: D 41. Meckel's diverticulitis most often occurs in the: A. Proximal jejunum. B. Distal jejunum. C. Proximal ileum. D. Distal ileum. Answer:D 42. A patient is seen in the emergency room with reproducible right lower quadrant tenderness. The approximate incidence of finding a normal appendix on right lower quadrant exploration in similar nonselected patients is which of the following: a. 5% b. 10% c. 20% d. 40% Answer: c 43. Of adult patients presenting to the emergency room for evaluation of acute abdominal pain, which one of the following answers includes the most common diagnoses? a. Urologic problems, cholelithiasis, pelvic inflammatory disease b. Mittelschmerz, appendicitis, ureterolithiasis c. Nonspecific abdominal pain, appendicitis, intestinal obstruction d. Appendicitis, pelvic inflammatory disease, perforated ulcer Answer: c 44. Nonsurgical causes of acute abdominal pain may include which of the following? a. Hyperthyrodism b. Adrenal insufficiency c. Pneumonia d. Diabetic ketoacidosis Answer: b, c, d 45. Which of the following cause visceral pain from the abdominal organs? a. Stretching and contraction b. Traction, compression, torsion c. Cutting d. Certain chemicals Answer: a, b, d 46. Factors which may influence the clinical presentation of intraabdominal pathology include which of the following? a. Pregnancy b. Oral anticoagulants c. Age d. HIV infection Answer: a, b, c, d 47. Prospective studies have shown incidental appendectomy to be advantageous in which of the following patient groups? a. Children undergoing staging laparotomy for malignancy who are then to enter chemotherapy b. HIV infected patients c. Patients over 50 years of age d. Patients with spinal cord injuries e. None of the above Answer: e 48. Visceral pain is typically: a. Well localized b. Sharp c. Mediated via spinal nerves d. Perceived to be in the midline Answer: d 49. True statements regarding the pathophysiology of acute appendicitis include which of the following: a. Fecaliths are responsible for the disease process in approximately 30% of adult patients b. Lymphoid hyperplasia is a rare cause of appendicitis in young patients c. Clostridium difficile is implicated as a pathogenic organism d. Carcinoid tumors account for approximately 5% of all cases of acute appendicitis Answer: a 50. A 26-year old woman in her first trimester of pregnancy presents with a 2-day history of right lower quadrant pain and fever. Physical examination reveals a tender, palpable, right lower quadrant mass. There is no evidence of peritonitis or systemic sepsis. Laboratory evaluation is remarkable for mild leukocytosis, and abdominal ultrasound demonstrates an inflammatory mass but no evidence of abscess. As the surgeon on call, your recommendation would be: b. Intravenous hydration, antibiotic prophylasis, and urgent appendectomy c. Intravenous hydration, antibiotics, bowel rest, and interval appendectomy in 4 to 6 weeks d. Intravenous hydration, antibiotics, and appendectomy if no improvement in 12 to 24 hours e. Intravenous hydration, antibiotics, and interval appendectomy when fever has subsided, leukocyte count has returned to normal, and the patient is pain free f. Emergent obstetrical consultation for evaluation and treatment of possible ectopic pregnancy Answer: a 51. True statements regarding appendiceal neoplasms include which of the following? a. Carcinoid tumors of the appendix less than 1.5 cm are adequately treated by simple appendectomy b. Appendiceal carcinoma is associated with secondary tumors of the GI tract in up to 60% of patients c. Survival following right colectomy for a Dukes’ stage C appendiceal carcinoma is markedly better than that for a similarly staged colon cancer at 5 years d. Mucinous cystadenocarcinoma of the appendix is adequately treated by simple appendectomy, even in patients with rupture and mucinous ascites e. Up to 50% of patients with appendiceal carcinoma have metastatic disease, with the liver as the most common site of spread Answer: a ABDOMINAL WALL and ACUTE ABDOMEN Questions and Answers Download Read the full article

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juniperpublisherscasestudies · 5 years

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Juniper Publishers-Open Access Journal of Case Studies

Facial Nerve Palsy after General Anaesthesia, A Less Reported Complication: Case Report

Authored by Rajesh Chaudhary

Abstract

Peri-operative nerve injuries are less documented but known complications. They are more common after regional anaesthesia but may be seen after general anaesthesia too. Peripheral branches of facial nerve are likely to be injured due to pressure exerted during bag and mask ventilation or due to stretch exerted while pulling the jaw forward. Most of the times these injuries are transient and recover within the time period of few days to weeks without any residual effects or they could be serious and permanent. Difficult intubation may invite trouble and cause facial nerve injury.

Keywords: Facial nerve palsy; Neuroprexia; Peripheral nerve injuries; Regional anaest

Introduction

Injury to the peripheral nerves in the peri-operative period is a rare but sometimes serious, documented complication. These injuries are a source of great anxiety and morbidity to the patients and their families besides they are leading cause of insurance claims. According to one data these injuries are a cause of litigation against anaesthetists as high as 16% [1]. These injuries may be minor and transient or permanent. Although there exact incidence is not known but one study has put the permanent nerve damage after surgery and anaesthesia to be somewhere between 0.03%-1.4%. Facial nerve injury may be seen after general anaesthesia which usually improves with the passage of time leaving the permanent damage only in a minor number of patients. The nerve is vulnerable to trauma due to variability in its course or sometimes because of its superficial nature, which makes it vulnerable to pressure and stretch [2]. Use of inappropriate size laryngeal mask airway(LMA) or endotracheal tube or a difficult intubation increase the chances of injury as highlighted by this case.

Case

We present the case of a 48 year old male weighing 65 kg who was posted for elective cholecystectomy. There was no history of any co morbidities but a difficult intubation was anticipated by the anaesthetist in view of short neck and a large tongue. At the operating table the induction of anaesthesia was started by the anaesthetist with 2 (mg) miligram/kg of Propofol along with 2 microgram/kg of Fentanyl and 0.5 mg/kg of Succinylcholine was given intravenously after preoxygenation with 100% oxygen for three minutes with bag and mask. An Endotracheal tube of size 7.5 was used but the trachea could not be intubated.A size 6.5 tube also could not be negotiated into the trachea of the patient. Meanwhile the patient was again ventilated with 100% oxygen and laryngeal mask airway of size 4 was tried after proper lubrication with lignocaine jelly by another anaesthetist but the procedure again failed even after two attempts. The procedure was abandoned and patient shifted back towards after recovery. About six hours later the patient was seen in the wards. Patient complained of perioral numbness and difficulty in speaking. Angle of mouth was deviated towards left side. No other neurological sign was seen.Anticipating some cerebrovascular accident plain CT scan of the head was done and it was found to be normal. The case was discussed with the physician also but no obvious cause could be found. We had never seen such a condition before hence extensive search of literature available over internet was made. A transient injury of the facial nerve was kept as the diagnosis. Prognosis was explained to the patient and counselling done regarding future outcome of the condition. Within a week the patient made full recovery and is still in follow up.

Discussion

The perioperative peripheral nerve injuries are more common after regional anaesthesia techniques but are seen after general anaesthesia too. Different nerves injured in decreasing order of frequency are ulnar nerve, brachial plexus, lumbosacral root, spinal cord, sciatic nerve, median nerve, radial nerve and femoral nerve respectively. Facial nerve injury is further rare [3]. Peripheral facial nerve injury is a mononeuropathy which is more commonly idiopathic or primary as compared to secondary to known causes like trauma, tumors, ischemia, viral infections or local anaesthetic agent toxicity [4]. Facial nerve is primarily a motor nerve with small sensory component. Facial nerve emerges out of the skull through stylomastoid foramen and becomes superficial to the mandible by entering the parotid gland where it gives off temporal, zygomatic, buccal, marginal mandibular and cervical branches. The main trunk may give off branches at different level in relation to the parotid gland. Digital pressure behind the mandible or excessive pressure exerted by the facemask can cause a traumatic lesion of the facial nerve. Sometimes the branches of facial nerve may be superficial to the parotid gland making the buccal and marginal mandibular branches especially vulnerable to injury during bag and mask ventilation for general anaesthesia [5].On the basis of nerve pathology, Seddon [6] classified the nerve injuries into three categories. Neurapraxia is the simplest of injuries with damage only to the myelin sheath and an intact axon. The chances of recovery are excellent. When the axon is damaged but the endoneurium and supporting connective tissue framework is preserved, it is called Axonotmesis. The chances of recovery are variable. Neurotmesis is the most severe injury where the nerve is completely destroyed along with the connective tissue network and the chances of recovery are almost negligible [6].Facial nerve injury could be because of unknown (Idiopathic) or known (Secondary) causes. Idiopathic facial nerve injury is more common [4]. Various mechanisms of nerve injury are ischemia, direct trauma, stretch and compression, and drug toxicity. Patients having diabetes mellitus, smokers, poor general health, pre-existing neuropathies are more prone to nerve injuries. These injuries are more common in neurosurgery, cardiac surgeries, and orthopaedic surgeries and with longer hospital stays. Endotracheal intubation and laryngeal mask airway (LMA) are known to cause nerve injuries.Trauma while insertion or using a small size tube or LMA should be avoided. Inappropriate cuff size increases the chances of injury by exerting more pressure to occlude the airway [2]. Sometimes the jelly used while insertion of LMA may cause transient nerve paralysis. Onset of symptoms may be immediate in case of direct trauma to the nerve or may be delayed in case of inflammation and drug toxicities. The diagnosis is mainly clinical aided by MRI (Magnetic resonance imaging) and nerve conduction studies. Generally the recovery of peripheral facial nerve injuries is good with a complete recovery in about 85% over a period of weeks to months while as much as 15% may suffer a permanent damage leading to weakness, synkinesis, facial spasms, contractures, decreased tears or psychosocial effects [4].

Conclusion

The peripheral nerve injuries in the perioperative period are a less documented complication .They are a source of great discomfort for the patients and their families as well as a matter of litigation against the doctors. They are very rarely seen after general anaesthesia as compared to regional anaesthesia. Their incidence may be under reported and less but every reported case will add to the better understanding, early and good management of these injuries. They may be very less in context of total perioperative complications but are lifelong for those who suffer permanent damages. One should be aware about the possibility of a nerve injury. Patients should be counselled about the injury and it’s possible outcomes and followed up from time to time. A good sense of observation and awareness of a possible nerve injury may prevent such complications.

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com/journals.php

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To read more…Fulltext please click on: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555558.php

#Juniper Publishers #Juniper Publisher’s journals #Juniper Publishers Review #Juniper Publishers group #Emergency Medicine #Cardiology #Medical Genetics #Molecular Biology #Medicine Neurosurgery #Psychiatry #Urosurgery #Surgical Oncology

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velvetcream03-blog · 5 years

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Pregnancy / Third Trimester

Excited to chat with you and share more pregnancy updates. I am currently 37.5 weeks as I am writing this but wanted to get this post up before baby came! Hope you enjoy these updates and if there is anything else you are dying to know, please leave me a comment on this blog post and I will be sure to answer in the comments below. Also, can you even with these photos of Lola?? Her eyes just melt me.

WEIGHT GAINED As of the start of week 37, I have gained 21 pounds.

HOW BIG IS BABY By week 37, Baby is the size of a head of romaine lettuce. A little over 6 lbs!

BABY MOVEMENT This baby is having a dance party on the inside. Of what I have read, movements start to get smaller because there is less room to be moving around but I feel like for me personally movements are bigger and more of them! Baby has been head down since week 18 and his little foot/leg has been kicking and pushing me on the left this whole time. It’s crazy how I can feel it. Getting alot of pressure and punches in my lady parts (sorry… TMI) but little man is making his own plans to break out of uterus jail. HA.

HOW I’M FEELING: PHYSICALLY Heartburn + Reflux: I have never really experienced the kind of heartburn and reflux that I have with pregnancy and my heart goes out to people that have to deal with these symptoms in their normal non-preggo lives. It’s funny because Blake actually has always struggled with reflux and now… I feel his pain. When you are pregnant a lot of your muscles start to relax because of all the hormones and heartburn and reflux can pop up out of nowhere. And HOLY CRAP. It’s bad.

I had started feeling burning in my throat over the beginning weeks in this trimester and everything hit the fan one night. I had eaten an early dinner at 6pm at a favorite mexican spot and enjoyed chips and salsa and then a simple dinner and was out for much of the night on my feet. That night I went to bed and work up at 2am feeling hot, sweaty, and sick…. And then I vomited like 7 times from the reflux. That whole night was sheer hell. The next day…. Equally hellish. I remember crying to Blake that if the whole third trimester was going to be like this… I don’t know how I would survive it.

Luckily I had a doctors appointment soon after that and now take pepcid extra strength 20 mg morning and night. It’s been literally saving me. I have still had some instances of reflux even taking the meds but it’s helping so much so I am incredibly grateful. Other things I do are eat an earlier dinner, avoid reflux trigger foods at night and never lay down after eating. Now at 37 weeks luckily these symptoms have slowed down for me.

Peeing my pants: Guys, still peeing my pants on the regular. Since the baby has dropped lower I have alot more pressure on my bladder and I have to hit the bathroom again constantly. Almost more so than the first trimester.

Hello Nausea: I feel like week 28 hit and the nausea was instantly back. Just when I thought I had left that nasty symptom in the past… it came back. Luckily the nausea is not 24/7 and comes and goes some days and not other days. At least I know to keep extra snacks and crackers with me and that’s been helping.

Fat foot: If you follow me on instagram… you know the story of “Fat Foot.” It’s the dead of Summer heat where I live and even the humidity is up. The last 2 weeks my one foot has been swelling the minute I start to be on my feet as well as going outside. It almost started happening out the blue. My one foot swells incredibly and the other does not. It’s super bizarre. I spoke to my doctor and she said that sometimes one foot can swell more than the other depending on the side of the body the baby is favoring. Honestly there isn’t much I can do about but I will tell you what I have been doing. When I can, I will wear compression socks around the house but honestly, it’s so hot I don’t do this that often. I also do ice water baths to help with the inflammation. I also elevate my feet whenever possible. So for now, I just have to make fun of my fat foot and do the best I can. I hear the swelling can last after delivery as well so hoping fat foot disappears sometime soon.

Exhaustion: The exhaustion is REAL in the third trimester. I feel like when it hits 4pm, I become utterly useless. Knowing my body just runs out of steam so much quicker, I try to really focus earlier in the day. Luckily, I have an amazing husband who pretty much makes dinner every night so that I can keep my feet up and rest most nights. I think the important thing is that I listen to my body and rest when I need it.

The Uncomfortable Stage: Basically at a certain point during the day, my body is just completely uncomfortable. With baby almost at max capacity pushing on all my organs… my body is just FULL. Not much room for anything. So I become increasingly uncomfortable as the day goes on and by the evening, I feel like baby is pushing up into my boobs and pushing down on my bladder all at the same time.

Braxton Hicks?: I could not tell you if I really had braxton hicks yet but I will say that I have had some pain centered in the lower part of my pelvis come and go. It’s hard to pin point what all these sensations, pains and aches really are since this is my first child. But I will say, things are happening.

HOW I’M FEELING: MENTALLY Everyone keeps asking me “How I am feeling??” “Are you ready?” “Are you anxious? Excited?” Basically it’s ALL OF THE ABOVE. I have been pretty upfront with you guys that the process of being pregnant isn’t always my favorite. Pregnancy is HARD WORK and once the third trimester rolls around, these last few weeks can be extra challenging. I am both ready to meet our little man TOMORROW! And also feel like, “OMG I NEED MORE TIME TO PREPARE!” It’s a huge mixed bag of emotions. But really, we are so ready to meet our little baby and I think the sheer will to just meet him will start to disappear any of the lingering anxiety that might be there.

I am not going to lie, Labor has been on my mind and it scare me going into this big unknown process. We did take prepared childbirth classes at the hospital so they did paint a bigger picture for the birth scenarios that can typically take place in the hospital. While some of these classes were a big alarming, I will say that I am someone fueled by information. So educating myself on the process was important in helping me to enter into labor with an open mind. People always ask if we have a birth plan and the answer is no. I know babies tend to have a plan of their own and especially after going through the fertility process… I have had to give up alot of control and put trust in the process. My only labor preference if I can make one is to have an epidural. That is really one of my only preferences at the moment. Bottom line is that whatever it is that gets my baby out safely and healthy, that is what I want to do. I have tremendous trust in my doctor and the hospital and I know they will guide me in the right direction for my baby. My personal philosophy will be to go with the flow. Now, this is easier said than done but my goal is that with this kind of mindset will get me through this wild experience. So while the nerves are going, so is the excitement. I am only putting out good vibes for a great labor, healthy baby, and happy mama. Everyone LOVES to try to tell me their horror stories but you know what, check your story at the door. Nothing but good vibes over here that I am putting out to the universe. At one of our last appointments… and this is going to be a bit graphic… but the doctor said, “Ooo I feel his head!”… HOLY FREAKING CRAP. It put things into perspective just how soon we are going to meet our baby!!!!!!!!!!!!! Like wow. Blake and I had this huge smile and amazement on our face. How did we get so lucky to make it to this point. So much gratitude is filling these last few weeks of pregnancy you have no idea.

FETAL DIAGNOSTICS APPOINTMENTS Since the doctors discovered my marginal cord insertion, I have been getting monthly growth ultrasounds to check in and make sure that baby’s growth is on track. Everything has been perfect so far so we are very grateful to be tracking this. In addition to this, we started going to fetal diagnostics at 35 weeks. This entails going to the hospital and having baby’s heart and movements monitored for 20-40 minutes 2x a week. I also have my fluids checked to make sure everything is looking good. It’s alot of extra time for doctors appointments but whatever it takes to keep an eye on our baby boy I would do in a heartbeat. It also ends up giving Blake and I peace of mind knowing baby is growing and looking good.

HOW I’M SLEEPING I still sleep surprisingly well, all things considered. I wake up some nights to use the bathroom in the middle of the night but not every night. I do take unisom every night to help me sleep. My doctor suggested it when I was having troubles with restless sleeping and it’s REALLY helped me.

EXERCISE My energy levels are much lower than they have been so I have not been getting to the gym as much this trimester. I do try to push myself to go walk for 30 minutes on the treadmill when I am up for it. I do still go to prenatal yoga once a week to continue and keep up with all my stretching and mindfulness practices. I continue to listen to my body and if I really don’t feel up to making it to the gym, I take time and rest. It’s so important that I listen to what my body needs.

CHALLENGES Tying my shoes: Thank goodness that Blake can help to tie my shoes some days or take my shoes off. Basically things close to the floor are now dead to me. Hahahaha.

Full stomach: I barely have any room for dinner these days. I am just so full by the time dinner time rolls around so sometimes eating dinner is a big struggle. I try to really enjoy a bigger breakfast or lunch when my appetite and stomach allow for a bigger meal. We also try to eat dinner a bit on the earlier side as well.

Body slowing down: I think it’s hard to accept that my body has slowed down quite a bit in this last trimester. I try to push myself to my original limits but I just can’t do some of the things I used to do because I don’t have the energy, or I am physically just unable to do them. All of this is ok but it’s funny because you expect to be able to do certain things and it always comes to be a shock at first when you can’t. The heat has been finally getting to me and slowing me down big time. Thank goodness we have air conditioning so I can be home in my icebox while Blake tries to play thermostat wars with me. If you want to know how to anger a pregnant lady, just mess with her thermostat. YOU WILL LOSE. HA!

WHAT I’M WEARING Most days if I am running errands or working at the house I am in gym or lounge clothes. Whatever is most comfortable. If I am getting dresses, I basically rotate through all my tank dresses. It’s what I am most comfortable. Since I am nearing the end of pregnancy, I have put a hold on buying anymore clothes. So I am mostly cycling through my favorite pieces that still fit. This includes dresses like this, this, this and this. I have also loved dressier pieces from naked wardrobe which are surprisingly lined pretty well.

JUST THE TWO OF US (plus Lola!) Blake and I have been making it a point to head to our favorite restaurants and just spend time doing some of the things we love just the two of us (or with Lola by our side!). Alot of my mom friends recommended we take advantage of this time and make date night a big priority. So we are doing that big time. We are also making sure to do some extra special things with Lola. Extra trips to the beach to sit and read our kindles. Enjoying our quiet time sleeping in and enjoying this special time before our family grows.

BABY PREPARATIONS Our nursery is ALMOST complete!!! We are just waiting on the dresser to arrive. Of course… it might arrive after baby but you know what, it’s no big deal. I organized everything that would go into the dresser into bins and we set up a folding table in it’s place temporarily so that we could set up our changing pad etc to still have everything ready. Can’t wait for the dresser to arrive so the we can complete the room and get some photos to share with you. The room is feeling so ZEN to me and I know baby boy is going to love it.

We finally set up our SNOO this weekend so I am SO excited to finally put this thing into action. Since we plan to have the baby in the bassinet in our bedroom, I have my night light set up on my nightstand already and we will have some baby goodies set up in our bedroom for those late night feedings and diaper changes. We also set up our baby monitor (which Blake picked out) as well as our little owlet. I am so all about all of this great tech baby stuff and have heard amazing reviews from some of my mama friends. So I will be excited to finally try them out myself and report back if they live up to the hype.

I am also in FULL ON nesting mode. I have been cleaning out my closet, going through my dresser drawers, and all out prepping as much as possible to get our house clean and organized for baby. Even Blake is nesting hard making sure we are organized.

Our hospital bags are finally packed! You can get a sneak peek of what we are packing here but I am shooting photos for my blog post this week so I hope to share that soon for all your mamas-to-be that have sent me questions asking what we are bringing. I am also still working on my registry post for you guys. Stay tuned.

WHATS NEXT Baby watch is in full effect. With less than 3 weeks till my due date who knows what could happen!! I continue to go to fetal monitoring 2x a week as well as my weekly doctors appointments from here on out. Basically we are just waiting to meet our little person and I can’t wait for the day I get to share him with the world. I can’t wait to meet you Baby Boy.

Source: https://www.eatsleepwear.com/2018/08/13/pregnancy-third-trimester/

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kurtwarren54 · 6 years

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Pregnancy / Third Trimester

WEIGHT GAINED As of the start of week 37, I have gained 21 pounds.

HOW BIG IS BABY By week 37, Baby is the size of a head of romaine lettuce. A little over 6 lbs!

CHALLENGES Tying my shoes: Thank goodness that Blake can help to tie my shoes some days or take my shoes off. Basically things close to the floor are now dead to me. Hahahaha.

The post Pregnancy / Third Trimester appeared first on eat.sleep.wear. - Fashion & Lifestyle Blog by Kimberly Pesch.

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elizabethcariasa · 6 years

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Pregnancy / Third Trimester

WEIGHT GAINED As of the start of week 37, I have gained 21 pounds.

HOW BIG IS BABY By week 37, Baby is the size of a head of romaine lettuce. A little over 6 lbs!

CHALLENGES Tying my shoes: Thank goodness that Blake can help to tie my shoes some days or take my shoes off. Basically things close to the floor are now dead to me. Hahahaha.

The post Pregnancy / Third Trimester appeared first on eat.sleep.wear. - Fashion & Lifestyle Blog by Kimberly Pesch.

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saltyloverrebel · 6 years

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Bhargava Spondin Drops, Homeopathy for Spondylitis

Spondin drops from Bhargava Phytolabs is an effective homeopathic treatment for neck and shoulder pain (spondylitis). It contains rutin (a type of flavonoid) which inhibits the release of histamine from cells thus reducing inflammation. Apart from physical relief, this medication also works towards fighting off any permanent damage to the spinal cord and nerves. It is suitable for ambulatory��

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mangrovesaltswamp · 7 years

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Coming to terms with so much.... The fact that I’m pretty sure I’m actually living with avoidant personality disorder and that Flint’s been the one with the borderline symptoms this whole time, and then recognizing the fact I probably do have obsessive compulsive on top of everything else despite the fact I’d dropped that consideration months ago

when I look at the repeated problems I’ve had, everything boils down to either:

1) I could not bring myself to speak up when I needed to so when I finally did react in a firm way, it came across as too sudden and more upset than I otherwise would have. Generally letting people push me until I snap because I think that’s what I deserve. Acting in a way that allows me to be a punching bag for others until I can’t take it anymore.

2) Being unwilling or unable to express even feeling “”negative”” emotions. Impulses to cover up any negative feelings toward someone with a cringe inducing, overly chipper attitude to hide the fact I’m actually super upset. Shrinking away from anger expressed towards me when I’m not expecting to receive it, normally seems to mainly occur when I’m legit caught off guard.

3) My incessant, suffocating chase after personal perfectionism, attention to details, efficiency, along with my own mental control. It explains me being a workaholic and it explains my extreme life-long problems with interpersonal communication. Also likely related to my ritualistic actions and when those aren’t taken, feeling itchy and as something Bad™ will happen if I don’t-do-the-thing.

4) Probably also explains why it took literal years before I could break my habit of not being able to handle not posting in perfect-textbook-English-grammar because my head would scream at me wrong, wrong, wrong, wrong until I went back to make edits on my text. The resulting shame that followed when I couldn’t explain to someone why it felt like such a big deal to me.

5) My sheer inability to stay socially consistent and somewhat not wanting to do that to begin with. The fact that its taken months for me to even sorta reliably text my partners because establishing that routine with anyone scared me half to death. Being very tough-and-go with friendships, even with people I view as very important to me or close, because I automatically assume I am intruding on others by merely existing.

6) Constant, physically damaging pain when I am not under control or express myself in ways because of my emotions that I hadn’t intended. Chest palpitations, varied breathing changes, migraines, blood pressure, muscle tension, vision blurring, and so on in reaction to stress when my brain believes I haven’t performed in an acceptable manner even if nothing actually unwanted comes out of it.

7) Behavior from me revolving around the entire concept that I am inherently replaceable to others. Less of it being a fear with the emotions tied to it and more of a ever present, deep seeded acceptance. And yeah, that also does go hand-in-hand with my post traumatic stress disorder reactions. It’s honestly far more of a tired resignation than it is a fear response.

8) The fact I always crave social critique to begin with because I’m always under the impression there is a Right and a Wrong way of doing so and that I, as an individual, somehow have no authority to decide this on my own because I don’t trust my own perception of the world around me. I view other people’s opinions and experiences are carrying more weight than my own.

9) The fact I assume any and all messages, no matter who it’s from, to be a source of danger. Opening messages or social media, alerts on anywhere, creating a fear response because I’m convinced it’ll be something hurtful. Opening messages, even from people I think I trust, takes will-power energy out of me to accomplish.

10) I’ll refuse to use specific words because they “”look Wrong”” to my brain. Words that require the combining of already existing words in particular. Words like “underpin / under . pin” or “starfish / star . fish” or “windmill / wind . mill”. Certain English words are somewhat painful for me to look at for too long because of my brain’s Wrong! screaming reaction.

11) I kid you not, I’m literally willing to drive to entire other store that is miles away from convince because there’s no way I can use the Wrong! shaped hangers in my closet. Putting up clothes hangers that don’t look identical to the ones I already use would be sacrilegious, right? [insert sarcastic tone here]

12) My unwillingness to discard broken, old, or worn out items because my brain tells me I might need it again someday. Old sneakers with large enough holes at the bottom that I can wiggle three fingers in it? Still own it for some reason. English and math papers from school back when we were only around fourth grade? Obviously I need to keep that! What if I want to go back to study it later, I say. Cords from electronic chargers that I’ve already proven are broken and of no use to me? Still taking up space on bedroom floor. It’s absurd and I couldn’t even see that for the longest damn time.

Also, boy howdey, if this entire paragraphs isn’t me crystallized in text form:

“Perception of one's own and others' actions and beliefs tend to be polarised[citation needed] into "right" or "wrong", with little or no margin between the two. For people with this disorder, rigidity could place strain on interpersonal relationships, with occasional frustration turning into anger and even varying degrees of violence. This is known as disinhibition.[8] People with OCPD often tend to general pessimism and/or underlying form(s) of depression.[9][10][11]This can at times become so serious that suicide is a risk.[12] Indeed, one study suggests that personality disorders are a substrate to psychiatric morbidity. They may cause more problems in functioning than a major depressive episode.[13]“

along with,

“Millon's subtypesTheodore Millon identified five subtypes of the compulsive personality (2004).[15][16] Any compulsive personality may exhibit one or more of the following:Conscientious: (Including dependent features) Rule-bound and duty-bound; earnest, hardworking, meticulous, painstaking; indecisive, inflexible; marked self-doubts; dreads errors and mistakes.”

plus there’s,

“OCPD is characterized by eight behavioral or personality traits: rigidity and stubbornness, perfectionism that interferes with task completion, hypermorality and scrupulosity, overattention to detail, miserliness, an inability to discard worn or useless items, excessive devotion to work, and an inability to delegate tasks (APA, 2013). When recast in the alternative model of the DSM-5 as self and other-oriented, these were noted to reflect: difficulties in identity (sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions), self-direction (difficulty completing tasks and realizing goals, associated with rigid and unreasonably high and inflexible internal standards of behavior; overly conscientious and moralistic attitudes); along with difficulties in empathy (understanding others) and intimacy (work and rigidity interfering with relationships); accompanied by personality traits of rigid perfectionism (must be present), perseveration, intimacy avoidance, and restricted affectivity.”

#edited several times because I keep adding to it lmfao #hhhmmmm uummm filed away as brain mush talk #not exactly for outside readers I mean you can but this is here for my own logging

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kurtwarren54 · 6 years

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PREGNANCY / WEEK 20 TO 28

Excited to chat with you and share more pregnancy updates (and currently 29 weeks pregnant as I write this EEK!!!). Hope you enjoy these updates and if there is anything else you are dying to know, please leave me a comment on this blog post and I will be sure to include in my next update.

WEIGHT GAINED As of the start of week 28, I have gained 16 pounds.

HOW BIG IS BABY By week 28, Baby is the size of a large eggplant. A little over 2 lbs and about 14-15 inches.

BABY MOVEMENT This has been one of the most exciting things to happen during the second trimester. It started off as what felt like little gas bubbles popping in my stomach. I remember the first time I thought to myself, “OH MY GOD THAT IS THE BABY MOVING!!!!!!” And I put it in my calendar the first time that Blake felt a kick at 22 weeks! (Which was on April 23) It took me considerably longer to feel movement because of the position of my placenta. My placenta is both in the front and on top so doctor said it might take a touch longer for me to feel stronger movements. I am happy to report baby is dancing on the inside now and it’s such an incredible thing to finally be able to get that immediate knowledge that baby is inside doing well and able to actually kind of communicate with me that way. It’s also so special that Blake can feel the movement. It brings such a real element to the pregnancy that we have been waiting for till now!

HOW I’M FEELING: PHYSICALLY Headaches/Migraines: I have continued to have migraines during this time but they have started to settle down. My doctor allows me to take excedrin migraine at the onset (since I can always tell when they are coming on) as well as I lay down, put on my eye mask, and lay an ice pack on my forehead. This usually REALLY helps and has allowed me to not be taken out for an entire day or two because of them. As I have gotten closer to week 28, I have not had one for quite some time. So fingers crossed this time has passed.

Hip + Tailbone Pain: I started to get really intense pains in my hips and tailbone making it even difficult to walk. The pain has come and go and my strategy is to continue doing a lot of the stretches I learn in my prenatal yoga class which seems to be helping. I also make sure to sleep with a pillow (or A LOT of bunched up comforter between my knees) to relieve some pressure and that seems to help as well.

Peeing my pants: I am still peeing my pants on the regular over here. TMI I know… but let’s be real. It happens. Now Blake thinks it’s funny to see if he can get me to laugh so hard that I pee myself… NAUGHTY HUSBAND. I continue to pack panty liners with me in every single purse for those… just in case scenarios. But at this point, I think I should prob pack a spare outfit in my car for a super serious accident. We also recently started taking a prepared child birth class at our hospital and while facing each other on a mat during breathing exercises, Blake and I were literally laughing so hard I peed myself in class. AWESOME. Maybe I should just wear an adult diaper to my next class. In all honestly, I think it’s great he can make me laugh like this.

Bye Bye Nausea, Hello Energy: The nausea is gone and I have to say I am feeling much more “normal” if that is a word for it. It’s incredible how much nausea can really drag you down in every way and it’s been amazing to be able to start to enjoy my pregnancy in new ways.

HOW I’M FEELING: MENTALLY These weeks were right in the sweet spot for me. Because the physical symptoms started to subside, it’s like there was this huge breath of fresh air for me to breath in mentally. It’s easy to not love being pregnant when you feel like garbage 24/7 and I have to say, things started to get a little bit easier. I know I talked to you about not 100% LOVING being pregnant in my last update and I am happy to report that this chunk of time relieved some of that. While I still have this amazing respect for how difficult it is to go through pregnancy, it’s been a beautiful blessing to be able to fall in love a little bit more with my body, the process etc. Some days are harder and some are easier but being able to feel the baby, watch my body grow, it’s created this amazing little spark of love that I just can’t describe.

HIGH RISK DOCTOR APPTS So at our last scan, the anatomy scan, we saw a CPC (choroid plexus cyst) which had me FREAKING OUT. We went to our echocardiogram at the high risk doctor and quickly saw that the CPC was gone and that there was nothing to worry about. The heart all looked great as well. This was all amazing news. The doctor did however notice something going on with the placenta. He found what they call a “marginal cord insertion” where the umbilical cord inserts into the placenta within 2 cm’s from the outside of the placenta. There is also another type of cord insertion that is much more severe and worrisome but my doctor assured me that this was not that. Because they saw this, we now need to be monitored more frequently as the baby gets bigger to ensure he is growing on track and getting all the nutrients he needs from the placenta. We have been going every 4 weeks to monitor and everything has been looking good! At this point we just roll with the punches and know that is baby is growing, that is all that matters. And getting a little extra screen time with our little guy is never a bad thing.

GLUCOSE TEST At week 26, I headed to the doctors office for the dreaded Glucose test. The horror stories I heard… were endless. Let me tell you about my experience. It’s a fasting blood test so for a preggo that has nausea and needs to eat.. It’s not the most fun experience. But, considering my background in what I have done for this baby to date, I wasn’t really that worried about this test. I got there and was able to pick a glucose drink flavor that was refrigerated (which I think made it easier to drink) and I picked lemon lime. Like drinking a Sprite right? HA. They take 1 blood draw before you drink the beverage and then wait an hour, test again, and wait another hour and test again. I chugged water before the test so I would not be dehydrated which made the blood draws easier. Honestly, the experience wasn’t bad for me. I had my laptop with me and just kept myself busy working while I waited for each blood draw. All in all, it wasn’t my preferred activity but the experience wasn’t as bad as everyone made it out to be. Excited to tell you I PASSED!

WHAT I’M EATING My food preferences always seem to include some kind of dessert or sweets. Love having something on hand after dinner to get that little bit of a sweet tooth fix! We have been taking more frequent trips to grab ice cream and frozen yogurt and I am not mad about that! We also stock the freezer with ice pops, haagen daz bars, and yasso frozen yogurt bars (mint chip is my fav!) We cook a lot but I always love a good italian meal. Something about it comforts me. I also always have string cheese on hand as well a new favorite, Blue Diamond Honey Roasted almonds for when I want a sweet treat but also a little protein. Other than that, I pretty much am eating everything and have random cravings all the time where I tell Blake, “Hey you know what sounds good?? Strawberry shortcake.” Totally reasonable requests coming from me all the time. HA!

HOW I’M SLEEPING Sleep has been going ok. I have stopped taking the unisom for now as I have been sleeping through the night and don’t want to take things if I don’t really need them. If you remember, my doctor let me take unisom to help me with sleeping. I do toss and turn all night from side to side but generally that is how I usually sleep anyways. I have actually been sleeping without a body pillow. What I do is steal ALL of the comforter and bunch is between my knees and my feet since I move around so often. It’s working for me for now but I am sure that will change soon. I have my pillows handy for when I need them. I actually slept surprisingly well on our babymoon to Maui. Considering we were not in our own bed, I slept like a rock. Likely because of the time change and spending 8 hours a day in the sun.

EXERCISE I am still loving my prenatal yoga class every Friday and the stretches and practices I am learning are going to serve me well getting closer to Labor. I also still try to get to the gym when I can but after the babymoon, I have been more tired and getting to the gym less these days. I don’t force my body if I feel like I am too tired to go. I always listen to what my body needs. When I go, I still do the treadmill at an incline of 3 and speed of about 3.5 and then do some arm circuit machines. Thank goodness I have Blake who will keep me motivated and always ask if I want to join him at the gym. So when I feel up to it, I can go.

BODY IMAGE Last post I talked about body image and at this point in pregnancy I am feeling much more comfortable in my own skin. We headed to our babymoon around week 26 and I have to say, it’s the best I have felt my whole pregnancy. Maybe it was that sweet Hawaiian breeze… but it’s also likely because it was in the perfect sweet spot for my body and soul. My bump was finally loud and proud and something just clicked where I felt confident and beautiful. I spent my days in Hawaii in my bikinis with a smile plastered on my face, watching my baby boy move from the outside, and having literally the best time. Do I have cellulite? Hell yes. Are there things I might not love about my body? Of course. But you know what, there is way more love than anything else I have for my body at this part of the journey. Getting ready in the bathroom I would just start staring at my belly, thinking back about how much I dreamed of these days. To look into the mirror and stare back at a rounded growing belly. Every time I catch that reflection I take a minute to think about just how lucky we are.

BABYMOON If I can suggest one thing, take a babymoon. It doesn’t have to be a whole big vacation, it can even be just a weekend getaway. If you can make it happen, just slip away for the weekend with your significant other and take the time to indulge just the two of you. Have a nice meal, enjoy a sunset, anything. Looking back on our trip, I am so thankful we had the time to spend together and really just RELAX together. Without work or obligations getting in the way. Everyone LOVES to tell me how your life will forever change once that little love bug comes into our life but it’s really true that this time together just the two of us is so special. We scheduled a photoshoot with my dear friends of Love and Water to capture the moment and ended up with some incredible memories from our trip. For us, Maui is so special because we got married there 3 years ago and it was the start of our family of 2 (plus lola and the cats!). Being able to come back as a soon to be family of 3, was even more magical and I can’t wait to bring out little one to these exact same spots and create new memories in one of our favorite places.

CHALLENGES Hormonal meltdowns: The hormonal meltdowns are still real. ALL. THE. TIME. I really try to curb my unreasonable nature but at times it’s just impossible. So this continues to be one of those things throughout pregnancy that lingers but at this point, I think I (and Blake) are semi used to it by now.

WHAT I’M WEARING I recently did a post here sharing my babymoon wishlist and alot of things I wore while in Hawaii. I recently did a huge shopping haul before our trip and stocked up on alot of dresses. Honestly dresses are the easiest thing to wear and not feel constricted and it’s been so wonderful that is Summer and I can get away with doing that. It means that I can still buy non-maternity dresses to slip into as well. I have been lounging in this cute graphic tee, this little bit sexy cover up, and this dress that just makes me feel like a sexy, beautiful pregnant woman. I also picked up this bra that is not maternity and surprisingly cozy to wear under white tops and dresses for summer. I need to pick up another in black.

SELF LOVE Part of my self love routine has been scheduling time to get a mani pedi. Seems so simple but it’s always so fun to get to pamper yourself. I was able to enjoy an AMAZING prenatal massage on our babymoon and will likely schedule another massage in the coming month. Blake and I also continue to make time for date night every week. We either plan a new recipe we want to try together, or try a new restaurant to savour the time when we can just pick up on a whim. So important to focus on always strengthening our relationship and having fun along the way. Blake has been my rock and does SO much for me in general, and basically takes over cooking all the time so I can rest and he is basically the best husband around. I need to actively thank him more because without him, I would be a hot mess.

RECENT PURCHASES Babyletto Crib from Serena & Lily YAY!!! We got our crib and put it together. Alot of you asked about it and we bought it from Serena & Lily because apparently it’s been sold out alot of other places online. It’s modern, and beautiful and I am in love.

LexyPexy Pretzel Teeth because baby toys, I just can’t help myself

Hooded sweater + Disney Pants from Zara Zara kids is a dangerous place. I ordered a couple things that are so freaking cute. You know how I feel about disney and I bought these little disney joggers… that I wish came in my size!

BABY PREPARATIONS Like I said above, we finally have our crib and it’s set up, and it’s glorious!!! We are in full swing designing our nursery with my dear friend Anne who is making sure Baby Boy has the coolest room around town! We are not focused on a theme per say. We are more focused on soft neutrals and creating a warm rich texture based space. Will share a sneak peek with you all soon.

I am also currently working on my West Coast Baby Shower with the lovely ladies of Beijos Events which is making me just so happy. Excited to celebrate with all my friends out here! I have been sharing a lot of the baby products and gifts coming in from my registry and others and started to share them to my highlights on my IG profile. I will be sharing a roundup of my registry must haves as it’s been a number question lately for all you mama’s to be out there planning your own registries. I have to say, making a registry is VERY overwhelming for a first time mom that literally has no idea what they are doing. It took me SO long to comb through research and decided on things. So will be excited to share what I learned with you all.

I need to start planning for my hospital bag, Blake’s and Lola’s. That is high priority now as I want to be sure I am prepared for the unexpected.

WHATS NEXT Hopefully it will be smooth sailing into the third trimester and as the clock starts to tick down, I am sure I will have a bigger update for you all on what I am planning, how I am feeling etc. That’s all for now! Leave me a comment with any more questions you might have. Happy to answer!

photos by Love and Water

The post PREGNANCY / WEEK 20 TO 28 appeared first on eat.sleep.wear. - Fashion & Lifestyle Blog by Kimberly Pesch.

from Wellness http://www.eatsleepwear.com/2018/06/20/pregnancy-week-20-to-28/ via http://www.rssmix.com/

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kurtwarren54 · 6 years

Text

PREGNANCY / WEEK 20 TO 28

WEIGHT GAINED As of the start of week 28, I have gained 16 pounds.

HOW BIG IS BABY By week 28, Baby is the size of a large eggplant. A little over 2 lbs and about 14-15 inches.

LexyPexy Pretzel Teeth because baby toys, I just can’t help myself

I need to start planning for my hospital bag, Blake’s and Lola’s. That is high priority now as I want to be sure I am prepared for the unexpected.

photos by Love and Water

The post PREGNANCY / WEEK 20 TO 28 appeared first on eat.sleep.wear. - Fashion & Lifestyle Blog by Kimberly Pesch.

from Wellness http://www.eatsleepwear.com/2018/06/20/pregnancy-week-20-to-28/ via http://www.rssmix.com/

0 notes

elizabethcariasa · 6 years

Text

PREGNANCY / WEEK 20 TO 28

WEIGHT GAINED As of the start of week 28, I have gained 16 pounds.

HOW BIG IS BABY By week 28, Baby is the size of a large eggplant. A little over 2 lbs and about 14-15 inches.

LexyPexy Pretzel Teeth because baby toys, I just can’t help myself

I need to start planning for my hospital bag, Blake’s and Lola’s. That is high priority now as I want to be sure I am prepared for the unexpected.

photos by Love and Water

The post PREGNANCY / WEEK 20 TO 28 appeared first on eat.sleep.wear. - Fashion & Lifestyle Blog by Kimberly Pesch.

0 notes