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
Any tumor in testis is malignant until proven otherwise.
Because 99٪ of testicular tumors are malignant!
#Surgery
Because 99٪ of testicular tumors are malignant!
#Surgery
-The normal appendix may not be visualized on US.
-The diameter of the appendix is usually less than 6 mm. When visible, the normal appendix compresses when pressure is applied with the transducer.
-The inflamed appendix is noncompressible (using a technique called graded compression).
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-The diameter of the appendix is usually less than 6 mm. When visible, the normal appendix compresses when pressure is applied with the transducer.
-The inflamed appendix is noncompressible (using a technique called graded compression).
#Surgery
Pericardial tamponade
-Becks triad
•Hypotension
•Engorged neck veins (elevated JVP)
•Muffled heart sounds.
-Acue tamponade 👉🏼100 cc of blood
-Chronic tamponade 👉🏼700-1000 cc of blood.
(Chronic tamponade occurs in pericarditis due to TB, renal failure, liver failure, heart failure, tumor).
#Surgery
-Becks triad
•Hypotension
•Engorged neck veins (elevated JVP)
•Muffled heart sounds.
-Acue tamponade 👉🏼100 cc of blood
-Chronic tamponade 👉🏼700-1000 cc of blood.
(Chronic tamponade occurs in pericarditis due to TB, renal failure, liver failure, heart failure, tumor).
#Surgery
In TensionPneumothorax:
Needle puncture or needle decompression (wide bore needle): in the 2nd intercostal space at the level of mid-clavicular line, converting it into open pneumothorax allowing air to escape into atmosphere thus temporarily relief the tension pneumothorax.
#Surgery
Needle puncture or needle decompression (wide bore needle): in the 2nd intercostal space at the level of mid-clavicular line, converting it into open pneumothorax allowing air to escape into atmosphere thus temporarily relief the tension pneumothorax.
#Surgery
You must be able to identify the visceral pleural line(Fig.10-1) to make the definitive diagnosis of a pneumothorax!
-Visualization of the visceral pleural line—a must for the diagnosis.
#Surgery
-Visualization of the visceral pleural line—a must for the diagnosis.
#Surgery
Recognizing acute cholecystitis on US:
-The presence of gallstones, possibly impacted in the neck of the gallbladder or cystic duct) (Fig. 21-5)
-Thickening of the gallbladder wall (>3 mm) (see Fig. 21-5, A)
-Pericholecystic fluid (fluid around the gallbladder) (see Fig. 21-5, B)
- A positive sonographic Murphy sign (A positive Murphy sign in this case is pain that is elicited by compression of the gallbladder with the US probe).
•In the presence of gallstones and gallbladder wall thickening, US has a positive predictive value for acute cholecystitis as high as 94%.
#Surgery
-The presence of gallstones, possibly impacted in the neck of the gallbladder or cystic duct) (Fig. 21-5)
-Thickening of the gallbladder wall (>3 mm) (see Fig. 21-5, A)
-Pericholecystic fluid (fluid around the gallbladder) (see Fig. 21-5, B)
- A positive sonographic Murphy sign (A positive Murphy sign in this case is pain that is elicited by compression of the gallbladder with the US probe).
•In the presence of gallstones and gallbladder wall thickening, US has a positive predictive value for acute cholecystitis as high as 94%.
#Surgery
-In perforation of intra-abdominal viscus, liver dullness may become resonant due to air in peritoneal cavity.
#Surgery
#Surgery
-Edema due to fluid overload can usually be differentiated from that caused by hypoproteinemia based on clinical examination, in fluid overload the jugular venous pressure will be raised, whereas in hypoproteinemia it will not appear raised.
#Medicine
#Medicine
Phlegmasia cerulea dolens
-This literally means "painful blue swelling", it is a manifestation of extensive deep venous thrombosis affecting the ileofemoral vein.
#Surgery
-This literally means "painful blue swelling", it is a manifestation of extensive deep venous thrombosis affecting the ileofemoral vein.
#Surgery
Among the sources of bleeding, fractures are not to be taken lightly,
-For each rib fracture, blood loss can range from 100-200 mL,
-Tibial fractures can yield 300-500 mL,
-Femoral fractures can produce 800-1000 mL,
-Pelvic fractures may cause loss of more than 2000 mL.
#Surgery
-For each rib fracture, blood loss can range from 100-200 mL,
-Tibial fractures can yield 300-500 mL,
-Femoral fractures can produce 800-1000 mL,
-Pelvic fractures may cause loss of more than 2000 mL.
#Surgery
Massive hemothorax
-Massive hemothorax is defined as more than 1500 mL, or in the pediatric population more than 25% of blood volume in the pleural space.
-In blunt trauma, the source of bleeding is usually severed intercostal vessels from multiple rib fracture, and occasionally from lacerated lung parenchyma, in which case it is usually associated with an air leak (hemopneumothorax).
-Plain chest radiograph can usually estimate the amount of blood in the pleural cavity, but the only reliable way to quantify the amount of hemothorax is tube thoracostomy.
-In penetrating trauma, lacerated great vessel or a pulmonary hilar vessel is presumed in a patient with massive hemothorax.
-Massive hemothorax is an indication for operative intervention, however tube thoracostomy is still needed as lung re-expansion improves oxygenation, improves cardiac performance, and can temponade venous bleeding.
#Surgery
-Massive hemothorax is defined as more than 1500 mL, or in the pediatric population more than 25% of blood volume in the pleural space.
-In blunt trauma, the source of bleeding is usually severed intercostal vessels from multiple rib fracture, and occasionally from lacerated lung parenchyma, in which case it is usually associated with an air leak (hemopneumothorax).
-Plain chest radiograph can usually estimate the amount of blood in the pleural cavity, but the only reliable way to quantify the amount of hemothorax is tube thoracostomy.
-In penetrating trauma, lacerated great vessel or a pulmonary hilar vessel is presumed in a patient with massive hemothorax.
-Massive hemothorax is an indication for operative intervention, however tube thoracostomy is still needed as lung re-expansion improves oxygenation, improves cardiac performance, and can temponade venous bleeding.
#Surgery
Sigmoid Vs caecal volvulus
◼️Caecal volvulus is more common in females, whereas sigmoid volvulus is more common in males.
◼️On plain radiograph caecal volvulus shadow appears like a human embryo, referred to as embryo sign whereas sigmoid volvulus shadow resemble a coffee bean.
◼️The twist in caecal volvulus is usually clockwise (to remember it easily, volvulus on the right has its clock going the right direction), whereas that of sigmoid volvulus it is anticlockwise.
◼️On erect films, there is a single air fluid level in caecal volvulus and two air fluid levels in sigmoid volvulus.
◼️In both conditions, a barium enema reveal a bird beak deformity.
N.B above fig demonstrate risk factors in sigmoid volvulus.
#Surgery
◼️Caecal volvulus is more common in females, whereas sigmoid volvulus is more common in males.
◼️On plain radiograph caecal volvulus shadow appears like a human embryo, referred to as embryo sign whereas sigmoid volvulus shadow resemble a coffee bean.
◼️The twist in caecal volvulus is usually clockwise (to remember it easily, volvulus on the right has its clock going the right direction), whereas that of sigmoid volvulus it is anticlockwise.
◼️On erect films, there is a single air fluid level in caecal volvulus and two air fluid levels in sigmoid volvulus.
◼️In both conditions, a barium enema reveal a bird beak deformity.
N.B above fig demonstrate risk factors in sigmoid volvulus.
#Surgery