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Dr KK Aggarwal 03 July 2018
Morning MEDtalks with Dr KK Aggarwal 3rd July 2018
J P Nadda / Anupriya Patel/ Ashwini Kumar Choubey/ Dr Mahesh Sharma On Doctors Day
Smelly urine
If your wee smells more concentrated than normal, it could be an early sign of diabetes, revealed Now Patient’s Chief Medical Officer, Dr Andrew Thornber to Express.co.uk. Urine doesn’t usually smell at all - unless you’ve eaten foods like asparagus that could make it smell stronger.
Vedic Reference (Dr Mukta): The food articles that are heavy to digest should be taken in less amount and the light food articles can be taken in ample amount
अल्पादाने गुरूणां च लघूनां चातिसेवने|
मात्रा कारणमुद्दिष्टं द्रव्याणां गुरुलाघवे||३४०||
गुरूणामल्पमादेयं लघूनां तृप्तिरिष्यते|
मात्रां द्रव्याण्यपेक्षन्ते [१] मात्रा चाग्निमपेक्षते||३४१||
Charak samhita 27/340-341
CT in appendicitis
Low radiation (2-4 mSV), contrast or plain, abdominopelvic CT is the preferred test in suspected appendicitis in adults. CT has higher diagnostic accuracy than ultrasound or MRI. In patients with appendiceal perforation contrast improves the delineation of the phlegmon or abscess. The imaging features of acute appendicitis are enlarged appendiceal double-wall thickness (>6 mm) and appendiceal wall thickening (>2 mm).
Incidental gallstones
Gallstones that are diagnosed in an asymptomatic patient based on an imaging study done for an unrelated reason. Majority will remain asymptomatic. Patients who develop symptoms typically report biliary colic. It is rare for a previously asymptomatic patient to present with complications of gallstone disease without first having had episodes of biliary colic.
Wait until a patient becomes symptomatic before performing cholecystectomy prevents unnecessary surgery as majority with incidental gallstones will never develop biliary colic.
But go for prophylactic cholecystectomy in patients at increased risk for gallbladder cancer and are good surgical candidates (anomalous pancreatic ductal drainage where pancreatic duct drains into the common bile duct, gall bladder polyp, porcelain gallbladder and large gallstones of > 3 cm.
It may also have a role in the treatment of some patients with hemolytic disorders or those who are undergoing a gastric bypass.
Natural history of GB stone
Majority of patients with incidental gallstones will not develop symptoms attributable to the gallstones. Only 15% will become symptomatic during 15 years of follow-up
Patients who develop symptoms typically report biliary colic rather than symptoms associated with the complications of gallstone disease (such as cholecystitis, pancreatitis, and choledocholithiasis).
The classic description is of an intense, dull discomfort located in the right upper quadrant, epigastrium, or (less often) substernal area that may radiate to the back (particularly the right shoulder blade) The pain is usually steady and not colicky. The pain is often associated with diaphoresis, nausea, and vomiting. It is not exacerbated by movement and is not relieved by squatting, bowel movements, or passage of flatus
The pain typically lasts at least 30 minutes, plateauing within an hour. The pain then starts to subside, with an entire attack usually lasting less than six hours
Once a patient develops symptoms, the symptoms are likely to recur and the patient is at increased risk for the development of complications. 70 percent of those with a history of biliary colic developed recurrent symptoms within two years. Other complications of gallstone disease occur at a rate of approximately 1 to 2 percent per year
Diabetes and gall stones
Patients with diabetes mellitus are at increased risk for the development of severe gangrenous cholecystitis but the magnitude of the risk and the risks and costs of cholecystectomy do not warrant prophylactic cholecystectomy in patients with asymptomatic gallstones. Only 10 percent of the initially asymptomatic patients develop biliary colic and 4 percent develop other gallstone complications; these values are similar to the general population.
When to give aspirin in acute MI
The loading dose (300 mg water soluble) should be given as soon as possible after the diagnosis is made ( ER or ambulance) to any patient with a STEMI after the diagnosis is made irrespective of treatment strategy. There is no evidence that higher doses are more effective, and they may lead to greater gastric irritation.
Once the reperfusion strategy (PCI, fibrinolysis, or no reperfusion) has been chosen, give a P2Y12 receptor blocker to all patients.
PCI: ticagrelor or prasugrel
Streptokinase or tenecleptase: clopidogrel
No reperfusion therapy: Ticagrelor.
Participate in survey on Inflammatory bowel disease: https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform
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