A 49 yr old lady presented to the hospital with a 4 day history of abdominal pain. She was a patient with a high BMI of about 35, known to have Diabetes and hypertension. She was diagnosed to have an incarcerated incisional hernia. Echo at the time of admission showed hypokinesia of the inferior wall. She had a fair LV function with an EF of 58%.
She underwent an emergency laparotomy and incarcerated*, gangrenous** small bowel was found in an incisional hernia. Gangrenous bowel was excised and end to end anastomosis was done by the surgical team. She developed septic shock post op and required high ionotropic support. She developed oliguric AKI with metabolic acidosis. In view of circulatory shock, she was provided CRRT*** support in ICU for 36 hrs by the Nephrology and intensive care teams. She made a good recovery and renal function normalized. She was discharged in a stable condition.
*Incarcerated hernia is when a part of the bowel protrudes out of the abdomen and cannot be pushed inside.
**gangrene is the death of a body tissue due to lack of Oxygen suppy
*** CRRT is a 24 hour non-stop dialysis done in patients who are extremely unwell and have kidney failure.
A 45 yr old male patient was diagnosed with peripheral vascular disease in 2017 when he had presented with claudication pain in the left lower limb. He was a chronic smoker. CT angio at that time revealed diffuse atherosclerotic disease with significant narrowing and non opacifation of right internal iliac, bilateral femoral, popliteal and tibial arteries. He was treated with Aspirin, Clopidogrel, Heparin, Cilostazol and Pentoxifylline. He was later given 6 cycles of PGE-1 therapy with which he had partial improvement. Since late 2019, he was poorly compliant to medication with irregular follow up with recurrence of claudication pain.
He presented now with a one week history of left sided abdominal pain, predominantly after food intake associated with black stools. A possibility of mesenteric ischemia was considered and USG abdomen with Doppler revealed thickened jejunal folds with SMA thrombosis. CT angiogram also revealed SMA thrombosis with circumferential thickening of jejunum with associated fat stranding. He was anticoagulated with UFH while monitoring APTT and was later changed to LMWH. He was monitored for any evidence of bowel gangrene. He continued to have pain abdomen following food intake. Doppler after 5days and 10 days of heparin therapy revealed non clearance of thrombus with no blood flow. Then we took the help of our esteemed and very experienced cardiology colleagues.
Patient was taken up for SMA intervention. Occlusion of SMA was confirmed via angiography (1). SMA was crossed with a pilot wire and dilated with 4 mm balloon. Flow not established despite dilatation. In view of persistent thrombosis, reperfusion Catheter was placed in SMA and Streptokinase was infused over 48 hrs at 1ml / hr resulting in good reperfusion (2).
An anesthesiologist will meet with you before your surgery and ask you questions to assess your risk and suitability to give anaesthesia. These include questions such as:
- Do you have any health problems?
- Do you have any dental problems, such as loose teeth or false teeth?
- What medicines do you take, including over-the-counter medicines and supplements?
- Do you smoke, drink alcohol, or use any illegal drugs?
- Do you have any allergies to foods or medicines
- Have you or any of your relatives ever had a problem with anesthesia medicines?
In some cases, you might have a choice between different types of anesthesia.
Your anesthesiologist will also tell you how your anesthesia will be given and answer any questions you have. They will continually check your breathing, blood \ pressure, and heart rate during the procedure. If you have general anesthesia, your anesthesiologist also makes sure you stay unconscious.
Can I wake up during general anesthesia?
It is very rare to wake up during general anesthesia (less than 1 patient in every 15,000
operations). Your anesthesiologist constantly adjusts the medicines to keep you from waking up.
Are there any side effects from anesthesia?
Each type of anesthesia has possible side effects.
If you have a spinal block or epidural, the numbness will last for a few hours after your
procedure before wearing off. Other side effects can include:
- Headache – There is a small chance of getting a type of headache that can last for several days. This is sometimes called a “spinal headache.” It usually goes away on its own, but pain-relieving medicines and other treatments can help.
- Trouble urinating – Some patients have trouble emptying their bladders for a few hours after surgery until the anesthetic wears off.
If you have general anesthesia, you will likely feel a little groggy or confused for a short time after waking up. Other side effects can include:
- Feeling sick to your stomach (nausea) and throwing up (vomiting) – Your anesthesiologist can give you medicines for this problem.
- A sore throat – This can happen if you had a breathing tube. It usually gets better quickly.
This type of anesthesia uses medicine to numb a small part of your body so you don’t feel pain. It can be given as a cream, gel, or spray on the skin. It can also be given by an injection (shot) into the skin. You might be awake when you get local anesthesia.
This type of anesthesia blocks pain in one area of your body, such as an arm, leg, or the
lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called “sedatives.” Sedatives are given through a thin tube that goes into a vein, called an “IV.
One type of regional anesthesia is called a “spinal block.” The anesthesiologist puts a small needle in your lower back, and injects medicine to numb the nerves in your spine. It can be used for surgery done on your legs or inside your belly. Another type is an “epidural.” The anesthesiologist uses a needle to put a small tube (called a “catheter”) into your lower back, near the nerves in your spine. Some women get an epidural during childbirth. Other people get one for a surgical procedure or to control pain after surgery.
This type of anesthesia makes you unconscious so you can’t feel, see, or hear anything during surgery. Some of the medicines are given through an IV. Others are gases that you breathe. You might also get a breathing tube to help you breathe. If this happens, the anesthesiologist will carefully place the tube in your throat while you are asleep during general anesthesia, and remove it before you wake up.
In Trust Hospitals, doctor Surendranath, MS, Mch. has successfully removed a 10 kg Ovarian Tumor from a patient of age 70 years.
In Cardiology Department the first case of successful ‘His bundle’ pacing with permanent pacemaker implantation in Andhra Pradesh by Dr. Chandra Mouli DM cardiologist & EP specialist & Dept of Cardiology. 60 yr old patient who resented with an idio junctional rythm and syncope. Pre-procedure QRS duration was 110 m sec which came down to 92 m sec post pacemaker implantation.
The coronary arteries are the vessels that supply blood to the heart. Plaque or calcium build-up in the coronary arteries causes heart disease or can lead to a heart attack. A test called Coronary artery calcium (CAC) scoring can detect this build up and is a good predictor of coronary events. This test has been demonstrated to be a better predictor than cholesterol levels in medical studies.
This is done using special X Ray equipment called a CT scanner which takes pictures of the blood vessels supplying the heart. The entire procedure is usually completed with in about 10 Minutes.
How is a CAC score calculated?
A calcium score (sometimes called an Agatston score) is calculated based on the amount of plaque observed in the CT scan.
What is the significance of the CAC score?
Based on your score, your doctor will be able to do risk stratification and suggest preventive strategies or further evaluation.
- Zero: No plaque. Your risk of heart attack is low.
- 1 – 10: Small amount of plaque. You have less than a 10 percent chance of having heart disease, and your risk of heart attack is low.
- 11-100: Some plaque. You have mild heart disease and a moderate chance of heart attack. Your doctor may recommend other treatment in addition to lifestyle changes.
- 101 – 400: Moderate amount of plaque. Your chance of having a heart attack is moderate to high.
- Over 400: Large amount of plaque. This signifies that there is extensive deposition of calcium in the arteries. Your chance of heart attack is high and aggressive prevention strategies are to be used.
Diabetes and high blood pressure are the most common causes of CKD. If you have diabetes or high blood pressure, working with your doctor to keep your blood sugar and blood pressure under control is the best way to prevent kidney disease.
Living a healthy lifestyle can help prevent diabetes, high blood pressure and kidney disease, or help keep them under control. Follow these tips to lower your risk for kidney disease and the problems that cause it:
- Lose weight if you are overweight. An ideal BMI(Body Mass Index) is between 18.5 – 25.
- Be active. Regular exercise and physical activity helps control blood sugar levels.
- Drinking plenty of fluids keeps you well hydrated and your kidneys working well. Your doctor will suggest fluid restrictions as appropriate if you have kidney failure.
- Take medications as directed.
- Keep your blood pressure below 130/90, or ask your doctor what your ideal blood pressure target is.
- If you have diabetes, make sure your blood sugars are well controlled.
- Eat healthy and ensure your cholesterol is in the acceptable range.
- Eat foods lower in salt.
- Eat more fruits and vegetables. If you have kidney failure, make sure you follow dietary restrictions as suggested by your doctor.
About Chronic Kidney Disease
With chronic kidney disease or silent disease, the kidneys don’t usually fail all at once. Instead, kidney disease often progresses slowly over a period of years. This is good news because if CKD is caught early, medicines and lifestyle changes may help slow its progress and keep you feeling your best for as long as possible.
Glomerular Filtration Rate (GFR)
Glomerular filtration rate (GFR) is the best measure of kidney function. The GFR is the number used to figure out a person’s stage of kidney disease. A math formula using the person’s age, race, gender and their serum creatinine is used to calculate a GFR. A doctor will order a blood test to measure the serum creatinine level. Creatinine is a waste product that comes from muscle activity. When kidneys are working well they remove creatinine from the blood. As kidney function slows, blood levels of creatinine rise.
Below shows the five stages of CKD and GFR for each stage:
Getting tested for chronic kidney disease (CKD)
- If you are at risk, get regular tests to check for early kidney disease. Ask your doctor for blood or urine tests.
- Find it early to take preventative measures to stop kidney disease from progressing.
- If you have diabetes, get tested yearly for presence of kidney disease.