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
Radiological features helpful in diagnosis of development hip dysplasia
◼️Shenton's line, a curved line along the inferior edge of the superior pubic ramus in continuity with the femur (see above), in DDH this line is interrupted.
◼️Hilgenreiner line, a horizontal line taken through both triradiate cartilages (see above).
◼️Perkin's line, this is a vertical line perpendicular on the Hilgenreiner line drawn from the lateral edge of the triradiate cartilage, this intersection will form 4 quadrants, normally the femoral head should lie in the lower inner quadrant, whereas in DDH the femoral head lies in the upper outer quadrant.
#Surgery
◼️Shenton's line, a curved line along the inferior edge of the superior pubic ramus in continuity with the femur (see above), in DDH this line is interrupted.
◼️Hilgenreiner line, a horizontal line taken through both triradiate cartilages (see above).
◼️Perkin's line, this is a vertical line perpendicular on the Hilgenreiner line drawn from the lateral edge of the triradiate cartilage, this intersection will form 4 quadrants, normally the femoral head should lie in the lower inner quadrant, whereas in DDH the femoral head lies in the upper outer quadrant.
#Surgery
Complications of splenectomy
◼️Bleeding, may occur due to slipped ligature on the splenic artery, this can cause rapid exsanguination.
◼️Injury to surrounding organs, tail of the pancreas can be injured resulting in (1)Acute pancreatitis, (2)Pancreatic abscess, (3) Pancreatic fistula, injury to the stomach can cause hematemesis, also injury to the greater curve during ligation of short gastric vessels can cause gastric fistula, acute gastric dilatation may also occur.
◼️Infection, such as wound infection or a left subphrenic abscess.
◼️Pulmonary complications, including left basal atelectasis and pleural effusion.
◼️Overwhelming post-splenectomy infections by encapsulated organisms including pneumococci, meningococci, and H.influenzae, viral influenza infections can predispose to these bacterial infections so annual influenza vaccine should be considered.
◼️Thrombocytosis, this can cause thromboembolic manifestations, if the count reach more than 1 million per microlitre, aspirin should be given.
#Surgery
◼️Bleeding, may occur due to slipped ligature on the splenic artery, this can cause rapid exsanguination.
◼️Injury to surrounding organs, tail of the pancreas can be injured resulting in (1)Acute pancreatitis, (2)Pancreatic abscess, (3) Pancreatic fistula, injury to the stomach can cause hematemesis, also injury to the greater curve during ligation of short gastric vessels can cause gastric fistula, acute gastric dilatation may also occur.
◼️Infection, such as wound infection or a left subphrenic abscess.
◼️Pulmonary complications, including left basal atelectasis and pleural effusion.
◼️Overwhelming post-splenectomy infections by encapsulated organisms including pneumococci, meningococci, and H.influenzae, viral influenza infections can predispose to these bacterial infections so annual influenza vaccine should be considered.
◼️Thrombocytosis, this can cause thromboembolic manifestations, if the count reach more than 1 million per microlitre, aspirin should be given.
#Surgery
Testicular torsion
◼️Predisposing factors include (1) Undescended testis, (2) Spiral arrangement of cremasteric muscle, (3) Inversion of the testis, this is the most common factor in which the testis lies transversely and thus easily torted, (4) High investment of tunica vaginalis, also called Bell clapper anomaly, (5) wide seperation between the epididymis and the testis, it allows the testis to rotate without rotation of the cord.
◼️Clinically it present with sudden agonising pain in groin and lower abdomen, vomitting and mild pyrexia with or without scrotal swelling is common, the event usually occur after heavy lifting, straining or coitus, as these stimulate contraction of cremasteric muscle which is spirally arranged causing torsion.
◼️In epididymo-orchitis, pain is relieved by scrotal elevation, and associated urethritis is common.
◼️Duplex scan reveal reduced or no blood flow, when doubt exist exploration with bilateral fixation is required as the predisposing anomaly is bilateral.
#Surgery
◼️Predisposing factors include (1) Undescended testis, (2) Spiral arrangement of cremasteric muscle, (3) Inversion of the testis, this is the most common factor in which the testis lies transversely and thus easily torted, (4) High investment of tunica vaginalis, also called Bell clapper anomaly, (5) wide seperation between the epididymis and the testis, it allows the testis to rotate without rotation of the cord.
◼️Clinically it present with sudden agonising pain in groin and lower abdomen, vomitting and mild pyrexia with or without scrotal swelling is common, the event usually occur after heavy lifting, straining or coitus, as these stimulate contraction of cremasteric muscle which is spirally arranged causing torsion.
◼️In epididymo-orchitis, pain is relieved by scrotal elevation, and associated urethritis is common.
◼️Duplex scan reveal reduced or no blood flow, when doubt exist exploration with bilateral fixation is required as the predisposing anomaly is bilateral.
#Surgery
Signs of vascular trauma
◼️This is an essential part to recognize, a trauma to an artery may lead to acute spasm, or formation of a subintimal hematoma or acute thrombosis, all may occlude the vessel, alternatively a trauma may cause laceration of the vessel either completely or partially, remember: Partial laceration causes more bleeding than complete laceration.
◼️The HARD SIGNS of vascular trauma include (1) Pulsatile bleeding, (2) Pulsatile hematoma, (3) Signs of acute limb ischaemia, (4) Thrill or bruit due to traumatic AV fistula or a false aneurysm, (5) Rapidly Expanding hematoma.
◼️Soft signs include (1) Non pulsatile stable hematoma, (2) Unexplained shock or falling hemoglobin, (3) Injury at an anatomical site of an artery, (4) Evidence of nerve injury in proximity to an artery, (5) History of significant hemorrhage at time of trauma and before presentation.
#Surgery
◼️This is an essential part to recognize, a trauma to an artery may lead to acute spasm, or formation of a subintimal hematoma or acute thrombosis, all may occlude the vessel, alternatively a trauma may cause laceration of the vessel either completely or partially, remember: Partial laceration causes more bleeding than complete laceration.
◼️The HARD SIGNS of vascular trauma include (1) Pulsatile bleeding, (2) Pulsatile hematoma, (3) Signs of acute limb ischaemia, (4) Thrill or bruit due to traumatic AV fistula or a false aneurysm, (5) Rapidly Expanding hematoma.
◼️Soft signs include (1) Non pulsatile stable hematoma, (2) Unexplained shock or falling hemoglobin, (3) Injury at an anatomical site of an artery, (4) Evidence of nerve injury in proximity to an artery, (5) History of significant hemorrhage at time of trauma and before presentation.
#Surgery
Fontaine classification and the ankle brachial pressure index
◼️Fontaine classification is used to stratify the severity of an underlying lower limb arterial disease as follows:
Fontaine I = Asymptomatic.
Fontaine IIa = Intermittent claudication at a distance greater than 200 meters.
Fontaine IIb = Intermittent claudications at distance less than 200 meters.
Fontaine III = Rest pain.
Fontaine IV = Ulceration and gangrene.
◼️Ankle brachial pressure index (ABPI) is used to detect and quantify degree of arterial insufficiency, it is the ratio of systolic pressure at the ankle (posterior tibial or dorsalis pedis which ever is higher) and at brachial artery, the normal ratio is 0.9 to 1.3, ratio less than 0.9 indicate diseased arteries, less than 0.3 indicate imminent necrosis.
◼️Exercising the patient leads to dilatation of vascular spaces distal to an obstruction, if the feeding vessel is diseased it cannot keep pace with increased vascular space and thus ABPI will drop furthur.
#Surgery
◼️Fontaine classification is used to stratify the severity of an underlying lower limb arterial disease as follows:
Fontaine I = Asymptomatic.
Fontaine IIa = Intermittent claudication at a distance greater than 200 meters.
Fontaine IIb = Intermittent claudications at distance less than 200 meters.
Fontaine III = Rest pain.
Fontaine IV = Ulceration and gangrene.
◼️Ankle brachial pressure index (ABPI) is used to detect and quantify degree of arterial insufficiency, it is the ratio of systolic pressure at the ankle (posterior tibial or dorsalis pedis which ever is higher) and at brachial artery, the normal ratio is 0.9 to 1.3, ratio less than 0.9 indicate diseased arteries, less than 0.3 indicate imminent necrosis.
◼️Exercising the patient leads to dilatation of vascular spaces distal to an obstruction, if the feeding vessel is diseased it cannot keep pace with increased vascular space and thus ABPI will drop furthur.
#Surgery
French gauge (Fg) is a commonly used measuring unit for the size of catheters, this was described by a french instrument maker "Charriere", and it is the measurement of the cross sectional circumference of a catheter, so a three french gauge roughly means 1 mm when measuring the diameter rather than circumference.
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#Surgery