Academia-Zambia

17/07/2026

Ohooooo okay ….,, in uniform…

17/07/2026

17/07/2026

Good morning

16/07/2026

🦠 A patient is suspected of having acute bacterial meningitis, but lumbar puncture is delayed. What should be done immediately?

16/07/2026

💉 Which antibiotic should never be mixed or infused with Ringer’s lactate because it can form a dangerous calcium precipitate?

15/07/2026

BENIGN PROSTATE HYPERTROPHY (BPH)

Define Benign Prostate Hypertrophy

State causes of Benign Prostate Hypertrophy

State the pathophysiology of Benign Prostate Hypertrophy

State the signs and symptoms of Benign Prostate Hypertrophy

Discuss the management of Benign Prostate Hypertrophy

Outline the prevention of BPH

State the complications of Benign Prostate Hypertrophy

Definition

BPH is a non-cancerous condition in which the inner part of the prostate (around the urethra) often keeps growing as men get older. In BPH, the prostate tissue can press on the urethra, leading to problems passing urine.

BPH is not cancer and does not develop into cancer. But it can be a serious problem for some men. If it requires treatment, medicines can often be used to shrink the size of the prostate or to relax the muscles in it, which usually helps with urine flow.

CAUSES

Aetiology unknown

Related theories

Hormonal levels related to age. Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, leaving a higher proportion of estrogen within the prostate, increasing the activity of substances that promote prostate cell growth.

Another theory focuses on Dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. It indicates that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.

Other causes

Radiation

Age

Drugs (carcinogenic drugs)

Smoking increases the risk.

Infections.

SIGNS AND SYMPTOMS

Urinary frequency—urinating eight or more times a day

Urinary urgency—the inability to delay urination

Trouble starting a urine stream

A weak or interrupted urine stream

Dribbling at the end of urination

Nocturia—frequent urination during periods of sleep

Urinary retention

Urinary incontinence—the accidental loss of urine

Pain after ej*******on or during urination

Urine that has an unusual colour or smell

INVESTIGATIONS

Digital re**al examination: The Digital Re**al Examination (DRE) is an integral part of the evaluation in men with presumed BPH. During this portion of the examination, prostate size and contour can be assessed, nodules can be evaluated, and areas suggestive of malignancy can be detected.

Urinalysis: Examine the urine using dipstick methods and/or via centrifuged sediment evaluation to assess for the presence of blood, leukocytes, bacteria, protein, or glucose.

Urine culture: This may be useful to exclude infectious causes of irritative voiding and is usually performed if the initial urinalysis findings indicate an abnormality.

Prostate-specific antigen (PSA): Although BPH does not cause prostate cancer, men at risk for BPH are also at risk for this disease and should be screened accordingly.

Ultrasonography (abdominal, renal, transre**al) and intravenous urography are useful for helping to determine bladder and prostate size and the degree of hydronephrosis (if any) in patients with urinary retention or signs of renal insufficiency. Cystoscopy may be indicated in patients scheduled for invasive treatment or in whom a foreign body or malignancy is suspected.

DRUGS

Alpha-1 receptor blockers: By relaxing smooth muscle tissue found in the prostate and the bladder neck, these drugs allow urine to flow out of the bladder more easily, e.g. Terazosin 1–5 mg OD.

Side effects: The most important side effects of alpha blockers are dizziness and low blood pressure after sitting or standing up. Terazosin and doxazosin are usually taken at bedtime (to reduce light-headedness). The dose can be increased over time if needed.

SURGERY

Prostatectomy: Surgical removal of part or all of the prostate gland.

Indications

Gall stones

Hydroureteronephrosis

Infections

Prostate cancer

BPH

Radical Retropubic Prostatectomy: The entire gland and nearby lymph nodes are removed through an incision in the abdomen.

Radical Perineal Prostatectomy: The entire gland is removed through an incision between the sc***um and the a**s. Nearby lymph nodes can also be removed through a separate abdominal incision.

Laparoscopic prostatectomy: The entire gland and nearby lymph nodes are removed through several small incisions rather than one large incision. A laparoscope is used to remove the prostate.

Transurethral Resection of the Prostate (TURP): Part of the gland is removed using a long, thin device inserted through the urethra. TURP relieves urinary obstruction by removing tissue blocking urine flow.

NURSING CARE

Pre-operative care is the general one with few specifics.

Post-operative management in the first 48 hours.

Objectives

To allay anxiety

To promote comfort

To promote adequate nutrition and hydration

To prevent complications

To maintain the body’s normal physiological functions

AIRWAY

Nurse the patient with the head turned to the side to promote free drainage of secretions until fully awake.

PAIN MANAGEMENT

Pain may affect respiration.

Administer analgesia (Pethidine 1 ml/kg every 6 hours) until pain has reduced.

Ask the patient to splint the wound when coughing to reduce pain.

OBSERVATIONS

Observe blood pressure, pulse, and temperature every 15 minutes, every 30 minutes, hourly, then every 2 hours until stable.

Check the incision for bleeding.

Monitor urine output hourly.

Monitor suprapubic and surgical drain output hourly.

Monitor IV lines.

FLUID AND NUTRITION

Nil by mouth for the first 24 hours post-operatively until fully awake.

IV 5% Dextrose 2 ml/kg/day to maintain hydration and nutrition.

Introduce clear fluids when fully awake.

Gradually advance the diet from liquids to soft foods and then to a normal diet.

IV CARE

The IV line is used for hydration, nutrition, and drug administration.

Care of the cannula is important to prevent blockage and infection.

Aseptic technique should always be observed.

Monitor intake and output; urine output should be at least 2 ml/hour.

Calculate the prescribed IV fluid drip rate.

Remove the IV after about 48 hours unless medications still need to be administered.

THE URINARY BLADDER WASHOUT

A Foley catheter is inserted during surgery and remains in place for 3–5 days.

Perform catheter care twice daily.

Maintain aseptic technique.

Monitor intake and output; urine output should be at least 2 ml/hour.

WOUND AND DRAINAGE TUBE CARE

The surgical drain removes fluid from the operative site and is removed when drainage decreases, usually on the first, second, or third day.

Observe the colour of the drainage.

Observe drainage from the suprapubic tube.

Check for urine leakage around the suprapubic tube and report it to the surgeon.

The suprapubic drain is usually removed within 48 hours.

Maintain aseptic technique.

Other headings

Psychological care

Exercises

Elimination

Hygiene

COMPLICATIONS

Haemorrhage following surgery

Urinary bladder clot formation due to inadequate irrigation

Infertility if the spermatic cords are damaged

Urethral scarring

Urinary tract infections due to prolonged catheterization

Join us for lessons: 969512785

15/07/2026

ALCOHOL INTOXICATION( DRUNKENNESS)

QUESTIONS AND ANSWERS

1. Define alcohol intoxication
2. Discuss the pathophysiology of alcohol intoxication
3. Discuss alcohol overdose
4. Briefly Discuss the Blood alcohol concentration
5. Explain 7 stages of alcohol intoxication
6. Discuss the management of alcohol intoxication
7. Explain 5 Prevention of alcohol intoxication

INTRODUCTION

Alcohol intoxication, also known in overdose as alcohol poisoning, commonly described as drunkenness or inebriation,is the negative behavior and physical effects caused by a recent consumption of alcohol. In addition to the toxicity of ethanol, the main psychoactive component of alcoholic beverages, other physiological symptoms may arise from the activity of acetaldehyde, a metabolite of alcohol.

DEFINITION

Acute alcohol intoxication is a condition associated with drinking too much alcohol in a short amount of time. Alcohol poisoning is a serious and sometimes deadly consequence of drinking large amounts of alcohol in a short time.

PATHOPHYSIOLOGY OF ALCOHOL INTOXICATION

Alcohol is metabolized by a normal liver at the rate of about 8 grams of pure ethanol per hour. 8 grams or 10 mL (0.34 US ) is one British standard unit. An “abnormal” liver with conditions such as hepatitis, cirrhosis, gall bladder disease, and cancer is likely to result in a slower rate of metabolism. Ethanol is metabolised to acetaldehyde by alcohol dehydrogenase (ADH), which is found in many tissues, including the gastric mucosa. Acetaldehyde is metabolised to acetate by acetaldehyde dehydrogenase (ALDH), which is found predominantly in liver mitochondria. Acetate is used by the muscle cells to produce acetyl-CoA using the enzyme acetyl-CoA synthetase, and the acetyl-CoA is then used in the citric acid cycle. As drinking increases, people become sleepy or fall into a stupor. After a very high level of consumption[vague], the respiratory system becomes depressed and the person will stop breathing. Comatose patients may aspirate their vomit (resulting in vomitus in the lungs, which may cause “drowning” and later pneumonia if survived). CNS depression and impaired motor coordination along with poor judgment increase the likelihood of accidental injury occurring. It is estimated that about one-third of alcohol-related deaths are due to accidents and another 14% are from intentional injury.In addition to respiratory failure and accidents caused by its effects on the central nervous system, alcohol causes significant metabolic derangements. Hypoglycemia occurs due to ethanol’s inhibition of gluconeogenesis, especially in children, and may cause lactic acidosis, ketoacidosis, and acute kidney injury. Metabolic acidosis is compounded by respiratory failure. Patients may also present with hypothermia.

ALCOHOL OVERDOSE

An alcohol overdose occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions such as breathing, heart rate, and temperature control begin to shut down. Symptoms of alcohol overdose include mental confusion, difficulty remaining conscious, vomiting, seizure, trouble breathing, slow heart rate, clammy skin, dulled responses such as no gag reflex (which prevents choking), and extremely low body temperature. Alcohol overdose can lead to permanent brain damage or death.

BLOOD ALCOHOL CONCENTRATION ( BAC)

As blood alcohol concentration (BAC) increases, so does the effect of alcohol as well as the risk of harm. Even small increases in BAC can decrease motor coordination, make a person feel sick, and cloud judgment. This can increase an individual’s risk of being injured from falls or car crashes, experiencing acts of violence, and engaging in unprotected or unintended s*x. When BAC reaches high levels, blackouts (gaps in memory), loss of consciousness (passing out), and death can occur.

SIGNS AND SYMPTOMS OF AN ALCOHOL OVERDOSE

 Mental confusion, stupor
 Difficulty remaining conscious, or inability to wake up
 Vomiting
 Seizures
 Slow breathing (fewer than 8 breaths per minute)
 Irregular breathing (10 seconds or more between breaths)
 Slow heart rate
 Clammy skin
 Dulled responses, such as no gag reflex (which prevents choking)
 Extremely low body temperature, bluish skin color, or palenes.

STAGES OF ALCOHOL INTOXICATION

1. Sobriety, or subclinical intoxication.
2. Euphoria.
3. Excitement.
4. Confusion.
5. Stupor.
6. Coma.
7. Death.

EXPLAINATIONS ON STAGES OF ALCOHOL INTOXICATION

STAGE 1: SOBRIETY, or Subclinical Intoxication
At a BAC of 0.01-0.05, the individual is unlikely to appear intoxicated, though certain tests may detect impairment.2 Depending on the individual, judgment and reaction time may be slightly impaired.
STAGE 2: EUPHORIA
The second stage of alcohol intoxication, referred to as euphoria, occurs between 0.03 and 0.12 BAC (which may correspond to roughly 1-4 drinks for a woman or 2-5 for a man, depending on size).2,3 In this stage, the individual may feel more confident, may be more talkative and animated, and may feel slightly euphoric. Inhibitions also begin to decline.2 Most people refer to this stage as being “tipsy.”
STAGE 3: EXCITEMENT
Having a BAC between 0.09 and 0.25 lands a person into the third stage of alcohol intoxication: excitement. They may begin to experience emotional instability, a lack of critical judgment, and a significant delay in reaction time. They may start slurring their speech.
STAGE 4: CONFUSION
Someone with a BAC level of 0.18 to 0.30 is in the confusion stage, characterized by emotional upheaval and disorientation. Coordination is markedly impaired, to the extent that the person may not be able to stand up, may stagger if walking, and may be very dizzy.

Those in this stage of alcohol intoxication are highly likely to forget things that happen to or around them. “Blacking out” (losing memory of events that occurred while drinking) without actually passing out can happen at this stage.5.
STAGE 5: STUPOR
Infographic of the stages of alcohol intoxication based on number of drinks per hour
Stupor can occur at a BAC between approximately 0.25 and 0.40. Someone in this stage is extremely intoxicated and in dangerous territory, as they are at great risk of alcohol poisoning and death.6 They have likely lost a significant amount of motor function, are not responding to stimuli (or responding very slowly) and may be:
STAGE 6: COMA
A person who has reached 0.35-0.45 BAC is at significant risk of lapsing into a coma. Respiration and circulation are severely depressed, motor response and reflexes are markedly decreased, and the person’s body temperature drops. The person who has reached stage six of alcohol intoxication is at risk of death.2
STAGE 7: DEATH
At about 0.45 BAC or above, many are unable to sustain their vital life functions, and the risk of respiratory arrest and death is significant. Note that death is also possible at lower BACs.7

IMMEDIATE MANAGEMENT OF ALCOHOL INTOXICATION DRUGS

METADOXINE (pyridoxal L-2-pyrrolidine-5-carboxylate) has been shown to accelerate the elimination of alcohol in adults leading to faster recovery from intoxication and a more controlled withdrawal from alcohol. 1–3 It is given as a single intravenous administration and has few, if any, side-effects.
FOMEPIZOLE it’s an antidote; has been approved by the US Food and Drug Administration (FDA) for ethylene glycol poisoning, but it is also useful for managing methanol poisoning. B vitamins (ie, folic acid, pyridoxine, thiamine) may be useful in selected cases to reduce the toxicity of alcohol metabolites.
ADMINISTER FLUIDS INTRAVENOUSLY — with an IV — to prevent dehydration. Administer vitamins and sugar to treat low blood sugar. Insert a breathing tube to open the airways and provide more oxygen to the body. Pump the stomach to rid the body of excess alcohol.
STRATEGIES TO PREVENT ALCOHOL INTOXICATION
 Stop intoxicated patrons at the front door. …
 Monitor the drinking environment. …
 At functions, ensure the host knows that service will be refused to unduly intoxicated patrons, even if it they’re paying an all-inclusive price for the function. …
 Do not provide multiple drinks tickets.

To join the group : 969512785

15/07/2026

Peritonitis

Peritonitis is inflammation of the peritoneum, the thin membrane that lines the abdominal cavity and covers the abdominal organs. It is a medical and surgical emergency because it can rapidly lead to sepsis, shock, and death if untreated.

Types

1. Primary (Spontaneous) Peritonitis
Infection without a perforated abdominal organ.
Common in patients with liver cirrhosis and ascites.
2. Secondary Peritonitis (Most Common)
Occurs due to perforation or infection of an abdominal organ, such as:
Perforated appendicitis
Perforated peptic ulcer
Bowel perforation
Diverticulitis
Abdominal trauma
3. Tertiary Peritonitis
Persistent or recurrent infection despite treatment, usually in critically ill patients.

Causes

Perforated appendix
Perforated peptic ulcer
Intestinal perforation
Diverticulitis
Abdominal trauma
Pelvic inflammatory disease (PID)
Post-operative abdominal infection

Clinical Features

Sudden, severe abdominal pain
Generalized abdominal tenderness
Board-like abdominal rigidity
Guarding
Rebound tenderness
Fever
Nausea and vomiting
Abdominal distension
Absent or reduced bowel sounds (paralytic ileus)
Tachycardia
Hypotension (in severe cases)

Investigations

Full Blood Count (FBC): Elevated white blood cells
C-reactive protein (CRP): Elevated
Blood cultures: If sepsis is suspected
Serum electrolytes, urea, and creatinine
Abdominal X-ray: May show free air under the diaphragm if there is a perforation
Ultrasound: Can detect free fluid or abscess
CT scan: Best imaging test to identify the cause and extent of peritonitis

Management

Initial Resuscitation (ABC)
Secure airway if necessary
Give oxygen
Start IV fluids
Correct electrolyte imbalance
Insert a nasogastric tube if indicated
Insert a urinary catheter to monitor urine output
Medications
Broad-spectrum IV antibiotics
Adequate pain relief
Antiemetics if needed
Definitive Treatment
Emergency surgery (laparotomy or laparoscopy) to repair the source of infection or perforation
Drain any abscess or infected fluid

Complications

Sepsis
Septic shock
Intra-abdominal abscess
Paralytic ileus

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969512785

14/07/2026

Sialolithiasis