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General Signs and Symptoms of Abdominal Diseases
General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid. -
The Relationship Between Echolocation-Call Frequency and Moth Predation of a Tropical Bat Fauna
425 The relationship between echolocation-call frequency and moth predation of a tropical bat fauna C.R. Pavey, C.J. Burwell, and D.J. Milne Abstract: The allotonic frequency hypothesis proposes that the proportion of eared moths in the diet should be highest in bats whose echolocation calls are dominated by frequencies outside the optimum hearing range of moths i.e., <20 and >60 kHz. The hypothesis was tested on an ecologically diverse bat assemblage in northern tropical Australia that consisted of 23 species (5 families, 14 genera). Peak frequency of signals of bats within the echolocation assemblage ranged from 19.8 to 157 kHz but was greatest between 20 and 50 kHz. A strong positive relationship existed between peak call frequency and percentage of moths in the diet for a sample of 16 bats from the assemblage representing 13 genera (R2 = 0.54, p = 0.001). The relationship remained strong when the three species with low-intensity calls were excluded. When the two species with high duty cycle, constant-frequency signals were removed, the relationship was weaker but still significant. In contrast to previous research, eared moths constituted only 54% of moth captures in light traps at bat foraging grounds, and eared moths were significantly larger than non-eared individuals. These results show that the pattern of moth predation by tropical bats is similar to that already established for bat faunas in subtropi- cal and temperate regions. Résumé : L’hypothèse de la fréquence allotonique veut que la proportion de papillons de nuit à organes tympaniques soit maximale dans le régime alimentaire des chauves-souris dont les appels d’écholocation sont dominés par des fré- quences hors du registre d’audition optimal des papillons, c.-à-d. -
The Flank Incision and Exposure of the Kidney 2
THE FLANK INCISION AND EXPOSURE OF THE KIDNEY 2 Good flank exposure of the kid- perpendicular to the operating ney can be achieved by many sur- table and thus allows the operat- gical approaches. In general, the ing table to be rolled from side to kidney lies higher than expected side for improved exposure of the from the radiologic studies, with anterior or posterior kidney. the left kidney slightly higher Although the anterior superior than the right kidney. Except for iliac spine is positioned at the flex- lower pole renal biopsy, most op- ion of the table, when the table is erations require good exposure of fully flexed, the final position of the renal pelvis and the renal the body will cause the entire pedicle and thus call for either a pelvis to be slightly below the supra–twelfth-rib incision or a apex of the flexion and the ribs to twelfth-rib rib resection. In the fol- be slightly above, which creates lowing discussion of these two tension in the area of the lower approaches, important anatomic considerations for all flank expo- Flank Position sures are highlighted. FIG. 2-1. The flexion of the oper- Tension placed on Anterior Superior iliac spine ating table should be in line with ribs and skin in line with flexion of table the anterior superior iliac spine of the pelvis. This spine is a constant landmark that the surgeon can palpate in both thin and obese patients. After the patient is positioned on the side, the kidney rest can be elevated and the operating table flexed. -
Abdominal Pain
10 Abdominal Pain Adrian Miranda Acute abdominal pain is usually a self-limiting, benign condition that irritation, and lateralizes to one of four quadrants. Because of the is commonly caused by gastroenteritis, constipation, or a viral illness. relative localization of the noxious stimulation to the underlying The challenge is to identify children who require immediate evaluation peritoneum and the more anatomically specific and unilateral inner- for potentially life-threatening conditions. Chronic abdominal pain is vation (peripheral-nonautonomic nerves) of the peritoneum, it is also a common complaint in pediatric practices, as it comprises 2-4% usually easier to identify the precise anatomic location that is produc- of pediatric visits. At least 20% of children seek attention for chronic ing parietal pain (Fig. 10.2). abdominal pain by the age of 15 years. Up to 28% of children complain of abdominal pain at least once per week and only 2% seek medical ACUTE ABDOMINAL PAIN attention. The primary care physician, pediatrician, emergency physi- cian, and surgeon must be able to distinguish serious and potentially The clinician evaluating the child with abdominal pain of acute onset life-threatening diseases from more benign problems (Table 10.1). must decide quickly whether the child has a “surgical abdomen” (a Abdominal pain may be a single acute event (Tables 10.2 and 10.3), a serious medical problem necessitating treatment and admission to the recurring acute problem (as in abdominal migraine), or a chronic hospital) or a process that can be managed on an outpatient basis. problem (Table 10.4). The differential diagnosis is lengthy, differs from Even though surgical diagnoses are fewer than 10% of all causes of that in adults, and varies by age group. -
Terrestrial Native Mammals of Western Australia
TERRESTRIALNATIVE MAMMALS OF WESTERNAUSTRALIA On a number of occasionswe have been asked what D as y ce r cus u ist ica ud q-Mul Aara are the marsupialsof W.A. or what is the scientiflcname Anlechinusfla.t,ipes Matdo given to a palticular animal whosecommon name only A n t ec h i nus ap i ca I i s-Dlbbler rs known. Antechinusr osemondae-Little Red Antechinus As a guide,the following list of62 speciesof marsupials A nteclt itus mqcdonneIlens is-Red-eared Antechi nus and 59 speciesof othersis publishedbelow. Antechinus ? b ilar n i-Halney' s Antechinus Antec h in us mqculatrJ-Pismv Antechinus N ingaui r idei-Ride's Nirfaui - MARSUPALIA Ningauirinealvi Ealev's-KimNinsaui Ptaiigole*fuilissima beiiey Planigale Macropodidae Plani gale tenuirostris-Narrow-nosed Planigate Megaleia rufa Red Kangaroo Smi nt hopsis mu rina-Common Dulnart Macropus robustus-Etro Smin t hop[is longicaudat.t-Long-tailed Dunnart M acr opus fu Ii g inos,s-Western Grey Kangaroo Sminthops is cras sicaudat a-F at-tailed Dunnart Macrcpus antilo nus Antilope Kangaroo S-nint hopsi s froggal//- Larapinla Macropu"^agi /rs Sandy Wallaby Stnintllopsirgranuli,oer -Whire-railed Dunnart Macrcpus rirra Brush Wallaby Sninthopsis hir t ipes-Hairy -footed Dunnart M acro ptrs eugenii-T ammar Sminthopsiso oldea-^f r oughton's Dunnart Set oni x brac ltyuru s-Quokka A ntec h inomys lanrger-Wuhl-Wuhl On y ch oga I ea Lng uife r a-Kar r abul M.yr nte c o b ius fasc ialrls-N umbat Ony c hogalea Iunq ta-W \rrur.g Notoryctidae Lagorchest es conspic i Ilat us,Spectacied Hare-Wallaby Notorlctes -
České Vernakulární Jmenosloví Netopýrů. I. Návrh Úplného Jmenosloví
Vespertilio 13–14: 263–308, 2010 ISSN 1213-6123 České vernakulární jmenosloví netopýrů. I. Návrh úplného jmenosloví Petr Benda zoologické oddělení PM, Národní museum, Václavské nám. 68, CZ–115 79 Praha 1, Česko; katedra zoologie, PřF University Karlovy, Viničná 7, CZ–128 44 Praha 2, Česko; [email protected] Czech vernacular nomenclature of bats. I. Proposal of complete nomenclature. The first and also the last complete Czech vernacular nomenclature of bats was proposed by Presl (1834), who created names for three suborders (families), 31 genera and 110 species of bats (along with names for all other then known mammals). However, his nomenclature is almost forgotten and is not in common use any more. Although more or less representative Czech nomenclatures of bats were later proposed several times, they were never complete. The most comprehensive nomenclature was proposed by Anděra (1999), who gave names for all supra-generic taxa (mostly homonymial) and for 284 species within the order Chiroptera (ca. 31% of species names compiled by Koopman 1993). A new proposal of a complete Czech nomenclature of bats is given in the Appendix. The review of bat taxonomy by Simmons (2005) was adopted and complemented by several new taxa proposed in the last years (altogether ca. 1200 names). For all taxa, a Czech name (in binomial structure for species following the scientific zoological nomenclature) was adopted from previous vernacular nomenclatures or created as a new name, with an idea to give distinct original Czech generic names to representatives of all families, in cases of species- -rich families also of subfamilies or tribes. -
Left Flank Pain As the Sole Manifestation of Acute Pancreatitis
452 CASE REPORTS Emerg Med J: first published as 10.1136/emj.2003.013847 on 23 May 2005. Downloaded from Left flank pain as the sole manifestation of acute pancreatitis: a report of a case with an initial misdiagnosis J-H Chen, C-H Chern, J-D Chen, C-K How, L-M Wang, C-H Lee ............................................................................................................................... Emerg Med J 2005;22:452–453 On further review of the patient’s case 2 hours after the Acute pancreatitis is not an uncommon disease in an ultrasound examination, a decision was made to obtain a emergency department (ED). It manifests as upper abdominal computed tomography (CT) scan due to concern over the pain, sometimes with radiation of pain to the back and flank limitation of ultrasound studies in some clinical conditions. region. Isolated left flank pain being the sole manifestation of The CT showed abnormal fluid collection over the peri-renal acute pancreatitis is very rare and not previously identified in space and pancreatic tail as well as necrotic changes and the literature. In this report, we present a case of acute swelling of the pancreatic tail (fig 1). Serum pancreatic pancreatitis presenting solely with left flank pain. Having enzymes revealed a normal amylase (90 u/L) and a slightly negative findings on an ultrasound initially, she was elevated lipase level (336 u/L). The patient was diagnosed to misdiagnosed as having possible ‘‘acute pyelonephritis or have acute pancreatitis and admitted for supportive treat- other renal diseases’’. A second radiographic evaluation ment and monitoring. During her admission she was also with computed tomography showed pancreatitis in the tail noted to have hyperlipidemia (triglyceride 980 mg/dL and with abnormal fluid collected extending to the left peri-renal cholesterol 319 mg/dL). -
The Evolution of Echolocation in Bats: a Comparative Approach
The evolution of echolocation in bats: a comparative approach Alanna Collen A thesis submitted for the degree of Doctor of Philosophy from the Department of Genetics, Evolution and Environment, University College London. November 2012 Declaration Declaration I, Alanna Collen (née Maltby), confirm that the work presented in this thesis is my own. Where information has been derived from other sources, this is indicated in the thesis, and below: Chapter 1 This chapter is published in the Handbook of Mammalian Vocalisations (Maltby, Jones, & Jones) as a first authored book chapter with Gareth Jones and Kate Jones. Gareth Jones provided the research for the genetics section, and both Kate Jones and Gareth Jones providing comments and edits. Chapter 2 The raw echolocation call recordings in EchoBank were largely made and contributed by members of the ‘Echolocation Call Consortium’ (see full list in Chapter 2). The R code for the diversity maps was provided by Kamran Safi. Custom adjustments were made to the computer program SonoBat by developer Joe Szewczak, Humboldt State University, in order to select echolocation calls for measurement. Chapter 3 The supertree construction process was carried out using Perl scripts developed and provided by Olaf Bininda-Emonds, University of Oldenburg, and the supertree was run and dated by Olaf Bininda-Emonds. The source trees for the Pteropodidae were collected by Imperial College London MSc student Christina Ravinet. Chapter 4 Rob Freckleton, University of Sheffield, and Luke Harmon, University of Idaho, helped with R code implementation. 2 Declaration Chapter 5 Luke Harmon, University of Idaho, helped with R code implementation. Chapter 6 Joseph W. -
Natural History of Oregon Coast Mammals Chris Maser Bruce R
Forest Servile United States Depa~ment of the interior Bureau of Land Management General Technical Report PNW-133 September 1981 ser is a ~ildiife biologist, U.S. ~epa~rn e Interior, Bureau of La gement (stationed at Sciences Laboratory, Corvallis, Oregon. Science Center, ~ewpo Sciences Laborato~, Corvallis, Oregon. T. se is a soil scientist, U.S. wa t of culture, Forest Service, Pacific rthwest Forest and ange ~xperim Station, lnst~tute of orthern Forestry, Fairbanks, Alaska. Natural History of Oregon Coast Mammals Chris Maser Bruce R. Mate Jerry F. Franklin C. T. Dyrness Pacific Northwest Forest and Range Experiment Station U.S. Department of Agriculture Forest Service General Technical Report PNW-133 September 1981 Published in cooperation with the Bureau of Land Management U.S. Department of the Interior Abstract Maser, Chris, Bruce R. Mate, Jerry F. Franklin, and C. T. Dyrness. 1981. Natural history of Oregon coast mammals. USDA For. Serv. Gen. Tech. Rep. PNW-133, 496 p. Pac. Northwest For. and Range Exp. Stn., Portland, Oreg. The book presents detailed information on the biology, habitats, and life histories of the 96 species of mammals of the Oregon coast. Soils, geology, and vegetation are described and related to wildlife habitats for the 65 terrestrial and 31 marine species. The book is not simply an identification guide to the Oregon coast mammals but is a dynamic portrayal of their habits and habitats. Life histories are based on fieldwork and available literature. An extensive bibliography is included. Personal anecdotes of the authors provide entertaining reading. The book should be of use to students, educators, land-use planners, resource managers, wildlife biologists, and naturalists. -
Review of Australian Greater Long-Eared Bats Previously Known As Nyctophilus Timoriensis (Chiroptera: Vespertilionidae) and Some Associated Taxa H
A taxonomic review of Australian Greater Long-eared Bats previously known as Nyctophilus timoriensis (Chiroptera: Vespertilionidae) and some associated taxa H. E. Parnaby Hon. Research Associate, Mammal Section, Australian Museum, 6 College Street, Sydney NSW 2010, Australia. Email: [email protected]; and Department of Environment, Climate Change and Water NSW, PO Box 1967, Hurstville NSW 2220, Australia; and formerly BEES, University of New South Wales, Sydney NSW 2052. A comparative morphological and morphometric assessment was undertaken of material from mainland Australia, Tasmania and Papua New Guinea that has previously been referred to as the Greater Long-eared Bat Nyctophilus timoriensis (Geoffroy, 1806). Five taxa are recognised: N. major Gray, 1844 from south-western Western Australia; N. major tor subsp. nov. from southern Western Australia east to the Eyre Peninsula, South Australia; N. corbeni sp. nov. from eastern mainland Australia from eastern South Australia, through Victoria to Queensland; N. sherrini Thomas, 1915 from Tasmania, and N. shirleyae sp. nov. from Mt Missim, Papua New Guinea. Vespertilio timoriensis Geoffroy is regarded as nomen dubium due to uncertainty surrounding provenance of the original specimen(s), the lack of a definite type specimen, and lack of sufficient detail in the original description and illustration to relate the name to a singular, currently recognised species. This review required a consideration of two taxa not usually associated with timoriensis: bifax Thomas, 1915 from eastern Australia and New Guinea, and daedalus Thomas, 1915, previously treated as the western subspecies of bifax, occurring from western Queensland, the northern part of the Northern Territory, and northern Western Australia. -
1 Anatomy of the Abdominal Wall 1
Chapter 1 Anatomy of the Abdominal Wall 1 Orhan E. Arslan 1.1 Introduction The abdominal wall encompasses an area of the body boundedsuperiorlybythexiphoidprocessandcostal arch, and inferiorly by the inguinal ligament, pubic bones and the iliac crest. Epigastrium Visualization, palpation, percussion, and ausculta- Right Left tion of the anterolateral abdominal wall may reveal ab- hypochondriac hypochondriac normalities associated with abdominal organs, such as Transpyloric T12 Plane the liver, spleen, stomach, abdominal aorta, pancreas L1 and appendix, as well as thoracic and pelvic organs. L2 Right L3 Left Visible or palpable deformities such as swelling and Subcostal Lumbar (Lateral) Lumbar (Lateral) scars, pain and tenderness may reflect disease process- Plane L4 L5 es in the abdominal cavity or elsewhere. Pleural irrita- Intertuber- Left tion as a result of pleurisy or dislocation of the ribs may cular Iliac (inguinal) Plane result in pain that radiates to the anterior abdomen. Hypogastrium Pain from a diseased abdominal organ may refer to the Right Umbilical Iliac (inguinal) Region anterolateral abdomen and other parts of the body, e.g., cholecystitis produces pain in the shoulder area as well as the right hypochondriac region. The abdominal wall Fig. 1.1. Various regions of the anterior abdominal wall should be suspected as the source of the pain in indi- viduals who exhibit chronic and unremitting pain with minimal or no relationship to gastrointestinal func- the lower border of the first lumbar vertebra. The sub- tion, but which shows variation with changes of pos- costal plane that passes across the costal margins and ture [1]. This is also true when the anterior abdominal the upper border of the third lumbar vertebra may be wall tenderness is unchanged or exacerbated upon con- used instead of the transpyloric plane. -
Biodiversity Conservation on the Tiwi Islands, Northern Territory
BIODIVERSITY CONSERVATION ON THE TIWI ISLANDS, NORTHERN TERRITORY: Part 2. Fauna Report prepared by John Woinarski, Kym Brennan, Craig Hempel, Martin Armstrong, Damian Milne and Ray Chatto. Darwin, June 2003 Cover photograph. The False Water-rat Xeromys myoides. This Vulnerable species is known in the Northern Territory from six locations, including the Tiwi Islands. (Photo: Alex Dudley). i SUMMARY This is the second part of a three part report describing the biodiversity of the Tiwi Islands, and options for its conservation and management. The first part describes the Islands, their environments and plants. This part describes the fauna of the Tiwi Islands, and highlights the conservation values of that fauna. This report is concerned principally with terrestrial vertebrate fauna (frogs, reptiles, birds and mammals), and provides only limited information on fish, freshwater systems, marine systems and invertebrates. While Tiwi Aboriginal people have long held a deep knowledge of the fauna of their lands, this knowledge has only recently been documented. Scientific knowledge of the Tiwi fauna has improved substantially over the last decade. Until then, the most substantial contributions had come from collections, mostly of birds and mammals, in the period 1910-1920, that had provided a surprisingly thorough inventory of these groups. In this report we have collated all accessible information on the fauna of these Islands, and describe results from a major study undertaken over the last few years. This study has greatly increased the amount of information on the distribution, abundance, ecology and conservation status of the Tiwi Islands fauna. The Tiwi invertebrate fauna remains poorly known.