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.
#Surgery
#Surgery
Indications of mastectomy in early breast cancer rather than wide local excision followed by radiotherapy are:
1) Large tumour in relation to the size of the breast.
2) Central tumour below or involving the nipple.
3) Multifocality/ Multicentricity.
4) Patient's preference.
5) Local recurrence.
#Surgery
Serum thyroglobulin can be used as a serum marker for thyroid malignancy, and also to help diagnose factitious thyrotoxicosis whereby patient is taking exogenous thyroid hormones, in such case the serum thyroglobulin will be greatly depressed, another note to make, that antithyroglobulin antibodies may interfer with the interpretation of serum thyroglobulin in those with thyroid malignancy.
#Surgery
#Surgery
Differential diagnosis of right iliac fossa mass
◼️We can remember them as 4 iliocecal, 4 appendiceal, and 4 surrounding masses, these include the commonest causes and not all of them.
1) Four iliocaecal :
- Crohn's disease.
- Iliocaecal tuberculosis.
- Iliocaecal actinomycosis.
- Tumours of caecum and distal ileum.
2) Four appendiceal :
- Appendicular inflammatory mass.
- Appendicular abscess.
- Mucocele of vermiform appendix "see above figure".
- Appendicular tumours "most common is carcinoid tumour".
3) Four surrounding masses :
- Psoas abscess.
- Desmoid tumour.
- Hernia.
- Aneurysm of iliac artery.
#Surgery
◼️We can remember them as 4 iliocecal, 4 appendiceal, and 4 surrounding masses, these include the commonest causes and not all of them.
1) Four iliocaecal :
- Crohn's disease.
- Iliocaecal tuberculosis.
- Iliocaecal actinomycosis.
- Tumours of caecum and distal ileum.
2) Four appendiceal :
- Appendicular inflammatory mass.
- Appendicular abscess.
- Mucocele of vermiform appendix "see above figure".
- Appendicular tumours "most common is carcinoid tumour".
3) Four surrounding masses :
- Psoas abscess.
- Desmoid tumour.
- Hernia.
- Aneurysm of iliac artery.
#Surgery
Double duct sign, a sign of pancreatic head carcinoma seen on ERCP (endoscopic retrograde cholangiopancreatography), describes the concomitant dilatation of the pancreatic duct and bile duct due to obstruction by the carcinoma, note in the figure above how the gallbladder is also distended, going with Courvoisier law which state that when bile duct obstruction is due to a carcinoma, gallbladder is likely to be distended, and when it is due to gallstones, it is usually not distended as the organ is already shrivelled and inflamed and cannot be distended easily.
#Surgery
#Surgery
To differentiate between testicular torsion and acute epididymo-orchitis:
-If pain is relieved by scrotal elevation, it acute epididymo-orchitis.
-If pain is increased by scrotal elevation, then it's torsion. "Perhin's sign".
#Surgery
-If pain is relieved by scrotal elevation, it acute epididymo-orchitis.
-If pain is increased by scrotal elevation, then it's torsion. "Perhin's sign".
#Surgery