Cullen's sign:

-Periumbilical eccymoses seen in Retroperitoneal hemorrhage mostly with Acute pancreatitis.

Grey turner's sign :
-Seen with retroperitoneal hemorrhage , ecchymosis or dislocation of flank as result of dissecting blood from retroperitoneum as in AP.

Kehr's sign:
-Seen with splenic rupture, it is severe left shoulder pain (referred pain from diaphragmatic irritation).


#Surgery

Virchow's node:
Metastatic tumor to left supraclavicular node (usually due to gastric cancer).

#Surgery

-Painless progressive jaundice in elderly , consider as Pancreatic carcinoma until proven otherwise.

-Patient coming with acute onset aphasia , consider as Stroke until proven otherwise.

-Unilateral lower limb swelling consider as DVT until proven otherwise.

-Appearance of Iron deficiency in an adult male means GIT blood loss until proven otherwise.

-Painless hematuria in elder person consider as Bladder carcinoma until proven otherwise.

#Medicine

Urgent surgery is the surgery, which should be done early (within12–36hours).

#Surgery

What is the classic position of a patient with peritonitis?

-Motionless (often with knees flexed).


What is the classic position of a patient with a kidney stone?

-Cannot stay still, restless, writhing in pain.

#Surgery

What is a “left shift” on CBC differential?

-Sign of inflammatory response:
Immature neutrophils (bands)

-Note:
Many call 80% of WBCs as neutrophils a “left shift”.

#Surgery

What is gastroenteritis?

-Viral or bacterial infection of the GI tract, usually with vomiting and diarrhea, pain (usually after vomiting), nonsurgical.

#Surgery

What is the most common cause of RUQ pain?
-Cholelithiasis.

What is the most common cause of surgical RLQ pain?
-Diverticulitis.

What is the most common cause of GI tract LLQ pain?
-Acute appendicitis.

#Surgery

•What is more dangerous: a small or large hernia defect?

-Small defect is more dangerous because a tight defect is more likely to strangulate if incarcerated.

•Incarcerated means:
Swollen or fixed within the hernia sac (incarcerated imprisoned); may cause intestinal obstruction (i.e., an irreducible hernia).

•Incisional hernia:
-Hernia through an incisional site; most common cause is a wound infection.

•Epigastric hernia:
-Hernia through the linea alba above the umbilicus.

•Cooper’s hernia:
-Hernia through the femoral canal and tracking into the scrotum or labia majus.

#Surgery

•What are the layers of the abdominal wall?

Skin
Subcutaneous fat
Scarpa’s fascia
External oblique Internal oblique Transversus abdominus
Transversalis fascia
Preperitoneal fat
Peritoneum

•Note:
-All three muscle layer aponeuroses form the anterior rectus sheath, with the posterior rectus sheath being deficient below the arcuate line.

#Surgery

What is the conjoint tendon?

-Aponeurotic attachments of the “conjoining” of the internal oblique and transversus abdominis to the pubic tubercle.

#Surgery

US Criteria of Acute cholecystitis:

-GB stone
-Biliary sludge "turbid bile"
-Thickened wall
-Strip of fluid" pericholecystitis"

#Surgery

Synthetic mesh.

Criteria of an ideal mesh.
#Surgery

VENTRAL HERNIA:

-Any protrusion through abdominal wall with the exception of hernia through the inguinofemoral region is defined as ventral hernia.
-Incisional hernia (80%) and primary defects in abdominal fascia which can cause umbilical hernia, epigastric hernia, paraumbilical hernia or Spigelian hernia are grouped under ventral hernia.

#Surgery

RECURRENT HERNIA (Inguinal)

-Incidence is 10%.
-If recurrence is within 3 years it is called as early.
-If it is after 3 years it is late.

#Surgery

NON-UNION:

-Fracture not united at end of 9 months and there is no progress in fracture healing in last 3 months is Non-union.

#Surgery

Delayed Union:
-If no healing by > 3 months but less than 6 months.

Non-Union:
-If no healing by > 6 months.

#Surgery

How to know if the chest tube is functioning or not?

-Swinging movement of fluid in the tube, if not ask the patient to cough.
-Air bubbles.

#Surgery

When we should remove chest tube?

A-In pneumothorax:
1. If there is no air bubbles or air leak.
2. If there is no swinging movement.

-Clump the tube for 24 hr and do X-ray, if the lung expanded open the clump and ask patient to cough if there are air bubbles leave the tube , if not, remove it.

B-In hemothorax or chylothorax or pyothorax:
-No discharge for 24-48 hr.

C-In effusion:
-If there is Small amount of fluid we can remove the tube (large amount- not remove it).
-Depend on the fluid collection in the bottle and the X-ray.
-Normal plural fluid is 50-100 cc.

#Surgery

How can you clinically confirm that an NGT is in the stomach?

-Use a Toomey syringe to “inject” air while listening over the stomach with a stethoscope; you will hear the “swish” if the NGT is in place.

#Surgery