EPIDEMIOLOGY
Prevalence 10%
F>M (2:1)
Incidence increases with age
“ Female, fat, fertile, fifty, fare”- kind of true.
AETIOLOGY
Cholesterol supersaturation.
Cholesterol normally dissolved in lecithin-bile acid.
If the concentration of cholesterol increases, no more can dissolve ie supersaturated.

Cholesterol stones (20%):
Solitary or multiple.
High cholesterol states, pregnancy, DM, Pill.
Strawberry Gall Bladder- is cholesterosis of GB with mucosa studded with sub-mucosa cholesterol.
Bile pigment stones (5%):
Small, black, irregular, multiple and gritty.
Haemolytic anaemias.
Mixed stones (75%)
Multiple.
Generations of stones
Due to precipitation of cholesterol.
Tags: Gall stones, cholesterol, bile

GALL BLADDER:
Biliary colic Acute cholecystitis Empyema Mucocele Chronic cholecystitis.COMMON BILE DUCT:

10-14 % of patients with GS have duct stones.
Duct stones are responsible for:
Obstructive Jaundice:
Jaundice, dark urine, pale stool, pririts.
alk phos with min ALT 
 bilirubin
USS = dilated bile ducts.
ERCP and cholecystectomy in future.

Hernia is defined as an abnormal protrusion of a viscus or a part of viscus through as opening , artificial or natural with a sac covering it.
Common hernias :
Inguinal hernia Incisional hernia Femoral hernia Umbilical hernia
Causes :
coughing obesity straining Intra-abominal malignancy
Parts-
covering sac - narrow in indirect hernia, wide in direct hernia( fundus,body , neck) content
Hernia without neck- direct hernia, incisional hernia

Preparation of work area to be used
a) Close nearby windows
b) Pull curtains around bed
c) Restrict activities around bed, e.g. dusting or mopping floor.
Preparation of Patient
a) Explain procedure to patient
b) Assist patient into suitable position that is both comfortable for them and convenient for
the procedure.
c) Clear space around wound of any blankets, receptacles, etc.

Preparation of equipment
a) When the treatment room is cleaned in the morning, trolleys should be washed with
general purpose detergent and dried.
b) Before each dressing wash and dry hand or decontaminate with alcohol hand-rub.
c) Top shelf: - Left empty
Bottom shelf: - Basic dressing pack
- Suitable lotion
- As you place packs onto trolley first check that they are sterile
and undamaged
If required, add: - Supplementary packs
- Instruments
- Pulp tray to receive used instruments
- Special dressings
- Bandage or adhesive tapes
- Extra disposal bag
Tags: aseptic, dressing, equipment

The aim of dressing any wound is to produce conditions in which healing can take place.
Choice of a suitable dressing material is an important part of infection prevention and the
healing process.
Non-surgical wounds, such as pressure sores, require hygienic rather than aseptic technique.
Similarly, there is little point in using a full aseptic technique to dress a clean surgical wound,
when the patient has just taken a bath or shower. Sterile materials are required, but the

Differential Diagnosis:
Stones:
History
Continuous loin to groin pain Suggesting ureteric stone Dull and aching pain Suggesting stone in minor/major calyces Hematuria Vomiting Sweating UTI symptoms Risk factors Poor fluid intake
Hyperparathyroidism Examination – Patient in agony
Benign Prostatic Hypertrophy:
History
Elderly men

Bladder neoplasms: >90% arise from transitional epithelium (most are malignant); bladder carcinomas clinically features:
Painless hematuria
Frequency, urgency, dysuria (urinary symptoms)
Later pyelonephritic complications

The salivary glands are the site of origin of a wide variety of neoplasms. The histopathology of these tumors is said to be the most complex and diverse of any organ in the body.
Salivary gland neoplasms are also relatively uncommon with an estimated annual incidence in the United States of 2.2 to 2.5 cases per 100,000 people; they constitute only about 2% of all head and neck neoplasms .
Nearly 80% of these tumors occur in the parotid glands, 15% in the submandibular glands and the remaining 5% in the sublingual and minor salivary glands.

The pleomorphic adenoma or benign mixed tumor is the most common of all salivary gland neoplasms. It comprises about 70% of all parotid tumors, 50% of all submandibular tumors, 45% of minor salivary gland tumors but only 6% of sublingual tumors.
The most common location of occurrence is the parotid (85%) followed by the minor salivary glands (10%), in which the palate, upper lip and buccal mucosa are most commonly affected.
These tumors are most often diagnosed in the 4th to 6th decades of life and are uncommon in children although they are second only to hemangiomas in this population.

The second most common benign parotid neoplasm is Warthin’s tumor, also known as papillary cystadenoma lymphomatosum. It makes up 6-10% of cases of parotid tumors and has only rarely been described as occurring outside the parotid gland. It is primarily a disease of older white males, often being diagnosed in the 4th to 7th decades of life and occurring with a male-to-female ratio of approximately 5:1. Bilateral or multicentric Warthin’s tumors are seen in 10% of cases. Three percent are associated with other benign or malignant tumors.

Oncocytomas are rare tumors that constitute only 2.3% of benign epithelial salivary gland neoplasms.
They are most often encountered after the sixth decade of life with a nearly equal male-to-female ratio of occurrence.
The majority of these tumors affect the parotid gland (78%), few affect the submandibular gland (9%), none are reported in the sublingual gland and minor salivary gland involvement is most often in the palate, buccal mucosa or tongue.
The clinical presentation of oncocytomas is essentially identical to other benign salivary tumors—a slowly growing, nontender mass, typically in the superficial lobe of the parotid. They are firm, may be multilobulated and mobile on exam. Oncocytomas, along with Warthin’s tumors, have been noted to demonstrate increased uptake of pertechnetate anion and therefore can be distinguished from some other neoplasms by using technetium-99m pertechnetate scintigraphy.

The term “monomorphic adenoma” refers to a group of rare salivary tumors that includes the basal cell, canalicular, sebaceous, glycogen-rich and clear cell adenoma. Of these, the basal cell adenoma is the most common. It constitutes 1.8% of benign epithelial salivary gland tumors and typically occurs in the 6th decade of life. There are conflicting reports of gender predilection for this tumor but it does seem to occur more frequently among Caucasians than African Americans. The majority of basal cell adenomas occur in the parotid gland where they present as a slowly enlarging firm mass. They are well-encapsulated, smooth tumors on gross inspection and are divided into four subtypes based on their microscopic appearance—solid, trabecular, tubular and membranous.

Mucoepidermoid carcinoma is the most common salivary gland malignancy and makes up between 5 and 9% of all salivary gland neoplasms. It develops most commonly in the major salivary glands, most often the parotid (45-70%). The second most common site of occurrence is the palate (18%). This tumor displays a uniform age distribution between the ages of 20 and 70 years, with a slight peak in occurrence in the 5th decade. Although it is rare before age 20, it is the most common salivary gland malignancy in the pediatric and adolescent populations. Mucoepidermoid carcinoma occurs more frequently in women than in men and in Caucasians than in African Americans.

Adenoid cystic carcinoma is the second most common salivary gland malignancy overall, but is the most common in the submandibular, sublingual and minor salivary glands.
It occurs equally in men and women, peaks in the 5th decade of life and is more common in Caucasians.
Clinical presentation is often an asymptomatic mass, however, this tumor is more likely than others to present with pain or paresthesias. Facial paralysis remains rare, but again, may be seen more frequently with adenoid cystic than with other tumors. Minor salivary gland involvement is characterized by a submucosal mass with or without pain and ulceration.

Positive strand RNA viruses—these include the:
Picorna
Toga

Segmented –RNA viruses—have more than one piece of RNA in their genome. orthomyxovirus bunyavirus arenavruses
Non-segmented –RNA viruses—contain only one piece of RNA in their genome.

Ambisense genome—these negative strand RNA viruses have genomes that can be negative strand and another part is positive strand. They have more complex forms of replication/transcription. They are all single strands of RNA.
Arena virus
Bunyaviruses

Tags: HIV, Rabies, Virus

Penetration results in the internalization of the virus or its nucleic acid.
1) Viruses penetrate cells through direct penetration such as the parvoviruses.
2) Fusion can also occur at the plasma membrane.
The retroviruses and the paramyxoviruses fuse with the membrane and are resopnseible for sycnctyium formation which is doue to the fusion of many adjacenet infected cells to generaget a giant cell containing many nuclei.
3) Receptor mediated endocytosis—this occurrs with the flu virus, rhabdovirus, and non-envoeloped viruses. Glycoproteins are used in this process and they can not get in unless the pH is low. This is facilitated by the fusion of the lysosome with the endosome—the pH drop allows for the release of the virus from the vesicle.

General strategy—the virus must enter the cell. Once inside it must transcribe its genome, replicate its genome, make viral proteins, assemble progeny viruses. Then it must get out of the cell.
For DNA viruses, transcription occurs in the nucleus of the cell. Transcription factors are important for the early phase of transcription and can come from the host cell, the virus or both.
Temporal regulation—timing of DNA transciption. Most have their transcription broken up into early genes and late genes. Early genes get transcribed immediately after the viral DNA gets into the nucleus. These genes influence the viral-cell interactions.

Water-soluble vitamins
Thiamine (B1) Anorexia, weakness, peripheral neuropathy, cardiac failure, cerebellar signs, Wernicke’s encephalopathy; collectively, termed beriberi
Riboflavin (B2) Angular stomatitis, cheilosis, geographic tongue, skin desquamation, seborrheic dermatitis, anemia
Niacin Dermatitis, dementia, diarrhea, angular stomatitis, painful tongue, headache; collectively, termed pellagra
Pyridoxine (B6) Seborrhea-like facies, cheilosis, glossitis, anemia, peripheral neuritis

Definition- Essential organic substances needed in small amounts in the diet for normal function, growth and maintenance of the body
Yield no energy to the body, they often participate in energy-yielding reactions
A, D, E, K are fat soluble
B, C are water soluble
B, K function as parts of coenzymes (compounds that help enzymes function)
Can’t be synthesized in the human body

ABSORPTION OF FAT-SOLUBLE VITAMINS
Vitamins A, D, E, and k are absorbed along with dietary fat
These vitamins then travel with dietary fats through the bloodstream to reach body cells
Special carriers in the bloodstream help distribute some of these vitamins
Far-soluble vitamins are stored mostly in the liver and fatty tissues
When fat absorption is efficient, about 40% to 90% of the fat-soluble vitamins are absorbed

The amount of vitamin A you consumer is very important as both deficiency and toxicity of this vitamin can cause severe problems
There is a very narrow range of optimal intakes between these two states
Vitamin A is found in foods in a variety of forms
Retinoid or preformed vitamin A, are only found in foods of animal origin, such as fish and organ meats

Not just a vitamin; it is in face primarily considered a hormone.
Skin cells can convert a cholesterol-like substance to the prohormone vitamin D, using sunlight
Overall, sun exposure provides about 90% of our vitamin D needs
Liver and kidney cells then convert the prohormone to its active hormone form
The amount of sun exposure needed by individuals to produce vitamin D depends on their skin color, age, time of day, season, and location

Fat-soluble antioxidant
Resides mostly in cell membranes
An antioxidant can form a barrier between a target molecule (an unsaturated fatty acid in a cell membrane) and a compound seeking its electrons
The antioxidant donates electrons or hydrogens to the electron-seeking compound
This protects other molecules or parts of a cell from having electrons stolen
If vitamin E is not available to do its job, electron-seeking compound-known as a free radial- can pull electrons from cell membranes, DNA, and other electron-dense cell components

FUNCTIONS OF VITAMIN K
vital for blood clotting
k stands for koagulation
activates proteins present in bone muscle, and kidneys
poor vitamin K intake has been linked to an increase in hip fractures in women
in adults, deficiencies of vitamin K have occurred when a person takes antibiotics for a long period

Most water-soluble vitamins are more readily excreted from the body than are fat-soluble vitamins
Since any excess generally ends up in the urine or stool and very little is stored, consuming good sources of the water-soluble vitamins regularly is important
Because they dissolve in water, large amounts of these vitamins can be lost during food processing and preparation
Light cooking methods, such as stir-frying, steaming and microwaving, best preserve vitamin content

Thiamin is used to help release energy from carbohydrates
Major sources of thiamin include pork, products, whole grains, ready-to-eat breakfast cereals, enriched grains, green beans, milk, orange, juice, organ meats, peanuts, and dried beans, and seeds

The coenzyme forms of riboflavin participate in many energy-yielding metabolic pathways
When cells form cellular energy using oxygen-requiring pathways, such as when fatty acids are broken down and burned for energy, the coenzymes of riboflavin are used
Major sources are milk, milk products, enriched grains, ready-to-eat breakfast cereals, meat, eggs

Coenzymes forms of niacin function in many cellular metabolic pathways
When cell energy is being utilized, a niacin coenzyme is used
Synthetic pathways in the cell-those that make new compounds-also often use a niacin coenzyme (this is especially true for fatty acid synthesis)
Most every cellular metabolic pathway uses a niacin coenzyme, a deficiency causes widespread changes in the body
The group of niacin deficiency symptoms is known as pellagra, which means rough or painful skin