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
-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
-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
-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
-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
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
-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
-GB stone
-Biliary sludge "turbid bile"
-Thickened wall
-Strip of fluid" pericholecystitis"
#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
-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.
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-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
-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
-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
-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
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
-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
Pfannenstiel (“fan-en-steel”):
-Low transverse abdominal incision with retraction of the rectus muscles laterally; most often used for gynecologic procedures, e.g. CS.
#Surgery
-Low transverse abdominal incision with retraction of the rectus muscles laterally; most often used for gynecologic procedures, e.g. CS.
#Surgery
What laboratory test must all women of childbearing age have before entering the O.R.?
-b-HCG and CBC because of the possibility of pregnancy and anemia from menses.
#Surgery
-b-HCG and CBC because of the possibility of pregnancy and anemia from menses.
#Surgery
Note
Globus pharyngeus is a sensation of a constant lump in the throat but no difficulty in swallowing, occurs especially in indivisuals with emotional disorders particularly women, results of barium studies and manometry are normal, treatment is mainly reassurance, some cases are associated with reflux esophagitis and may respond to the treatment of esophagitis.
Source : Harrison 16th edition
#Medicine
Globus pharyngeus is a sensation of a constant lump in the throat but no difficulty in swallowing, occurs especially in indivisuals with emotional disorders particularly women, results of barium studies and manometry are normal, treatment is mainly reassurance, some cases are associated with reflux esophagitis and may respond to the treatment of esophagitis.
Source : Harrison 16th edition
#Medicine