DEXA SCANS (Dual Energy Xray Absorptiometry)
-Simultaneous measurement of the passage of Xrays through the body é 2 diff.energies.
-Low Radiation, accurate, Can be performed on hip, spine, whole body, or any where
• If T score is > -1 ....................................... reassure patient
• If Tscore between (-1)&(-2)................. request DEXA of
hip/spine
• If Tscore < -2 (more -ve) ....................... treat, If monitoring required, refer for DEXA.
#Surgery
-Simultaneous measurement of the passage of Xrays through the body é 2 diff.energies.
-Low Radiation, accurate, Can be performed on hip, spine, whole body, or any where
• If T score is > -1 ....................................... reassure patient
• If Tscore between (-1)&(-2)................. request DEXA of
hip/spine
• If Tscore < -2 (more -ve) ....................... treat, If monitoring required, refer for DEXA.
#Surgery
Brown tumor:
-The brown tumor is a bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism.
-They are a form of osteitis fibrosa cystica.
-It is not a neoplasm, but rather simply a mass. It most commonly affects the maxilla and mandible, though any bone may be affected.
-Brown tumours are radiolucent on x-ray.
#Surgery
-The brown tumor is a bone lesion that arises in settings of excess osteoclast activity, such as hyperparathyroidism.
-They are a form of osteitis fibrosa cystica.
-It is not a neoplasm, but rather simply a mass. It most commonly affects the maxilla and mandible, though any bone may be affected.
-Brown tumours are radiolucent on x-ray.
#Surgery
-Characteristic brown coloration results from hemosiderin deposition into the osteolytic cysts.
-Hemosiderin deposition is not a distinctive feature of brown tumors; it may also be seen in giant cell tumors of the bone.
#Surgery
-Hemosiderin deposition is not a distinctive feature of brown tumors; it may also be seen in giant cell tumors of the bone.
#Surgery
Remember:
-Aspirin need not be stopped before surgery.
-Thyroid medications should be continued.
-Anti-hypertensives should be continued (even losartan).
-OCPs should be continued till day of surgery.
-Anti-depressants, anti-epileptics, anti-psychotics should be continued except TCA, which should be stopped 3 weeks before surgery due to risk of intra operative arrhythmia.
-Ticlopidine: 14 days before surgery.
-Clopidogrel: 7 days before surgery.
-Warfarin: 3 days before surgery.
-LMWH: 12 hours before surgery.
#Surgery
-Aspirin need not be stopped before surgery.
-Thyroid medications should be continued.
-Anti-hypertensives should be continued (even losartan).
-OCPs should be continued till day of surgery.
-Anti-depressants, anti-epileptics, anti-psychotics should be continued except TCA, which should be stopped 3 weeks before surgery due to risk of intra operative arrhythmia.
-Ticlopidine: 14 days before surgery.
-Clopidogrel: 7 days before surgery.
-Warfarin: 3 days before surgery.
-LMWH: 12 hours before surgery.
#Surgery
Causes of Postoperative FeverDay
2–5 days👉🏼Atelectasis of the lung.
3–5 days👉🏼Superficial and deep wound infection.
5 days👉🏼Chest infection including viral respiratory tract infection, UTI and thrombophlebitis.
>5 days👉🏼Wound infection, anastomotic leakage, intracavitary collections and abscesses.
#Surgery
2–5 days👉🏼Atelectasis of the lung.
3–5 days👉🏼Superficial and deep wound infection.
5 days👉🏼Chest infection including viral respiratory tract infection, UTI and thrombophlebitis.
>5 days👉🏼Wound infection, anastomotic leakage, intracavitary collections and abscesses.
#Surgery
Indications for Open Reduction
NOCAST
-Nonunion
-Open fracture
-Neurovascular Compromise
-Displaced intraArticular fracture
-Salter-Harris3,4,5
-PolyTrauma.
Other indications include:
-Failed closed reduction
-Unable to cast or apply traction due to site.
-Pathologic fractures
-Potential for improved function and/ or out comes with ORIF.
#Surgery
NOCAST
-Nonunion
-Open fracture
-Neurovascular Compromise
-Displaced intraArticular fracture
-Salter-Harris3,4,5
-PolyTrauma.
Other indications include:
-Failed closed reduction
-Unable to cast or apply traction due to site.
-Pathologic fractures
-Potential for improved function and/ or out comes with ORIF.
#Surgery
Gleason Grade of Carcinoma Prostate
(1–5)is asfollows:
1.Small uniform glands
2.More stroma between glands
3.Distinctly infiltrative margins
4.Irregular masses of neoplastic glands
5.Only occasional gland formation (undifferentiated).
#Surgery
(1–5)is asfollows:
1.Small uniform glands
2.More stroma between glands
3.Distinctly infiltrative margins
4.Irregular masses of neoplastic glands
5.Only occasional gland formation (undifferentiated).
#Surgery
Lugol’s Iodide Solution or Saturated Potassium Iodide.
-Administered 7-10 days preoperatively (three drops twice daily)
-Reduce vascularity of the gland and decrease the risk of precipitating thyroid storm.
-The major action of iodine in this situation is to inhibit release of thyroid hormone.
#Thyroid
-Administered 7-10 days preoperatively (three drops twice daily)
-Reduce vascularity of the gland and decrease the risk of precipitating thyroid storm.
-The major action of iodine in this situation is to inhibit release of thyroid hormone.
#Thyroid
Treatment of Hypospadius:
Staged Procedure
I. At the age of one and half years, surgical correction of the chordee is done.
II. At the age of 5–7 years, reconstruction of urethra is done using prepucial skin (ideal) or scrotal skin if the patient has been circumcised. Best is prepucial skin.
-Perineal urethrostomy is done for diversion.
-Perineal urethrostomy should be there until reconstruction of urethra takes up well (Denis-Browne procedure).
-MAGPI repair: Meatal advancement glandular repair—for glan-dular hypospadias.
#Surgery
Staged Procedure
I. At the age of one and half years, surgical correction of the chordee is done.
II. At the age of 5–7 years, reconstruction of urethra is done using prepucial skin (ideal) or scrotal skin if the patient has been circumcised. Best is prepucial skin.
-Perineal urethrostomy is done for diversion.
-Perineal urethrostomy should be there until reconstruction of urethra takes up well (Denis-Browne procedure).
-MAGPI repair: Meatal advancement glandular repair—for glan-dular hypospadias.
#Surgery
Remember:
-In hypospadias, circumcision is contraindicated as prepucial skin is required for future urethroplasty.
#Surgery
-In hypospadias, circumcision is contraindicated as prepucial skin is required for future urethroplasty.
#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
Bed sore score:
Grade 1: redness erythema not disappear with pressure.
Grade 2: superficial ulcer
Grade 3: superficial and subcutaneous tissue but not through fascia.
Grade 4: deep to muscles and joints.
#Surgery
Grade 1: redness erythema not disappear with pressure.
Grade 2: superficial ulcer
Grade 3: superficial and subcutaneous tissue but not through fascia.
Grade 4: deep to muscles and joints.
#Surgery
Exceptions of Courvoisier's law (in 20% of cases):
a-Calcular obstruction of CBD with palpable G.B. :
1.Metabolic stone with a healthy distensible G.B.
2.Stone in CBD & another stone in cystic duct .
3.A stone of Hartmann's pouch obstructing both cystic duct and CBD (Mirrizi syndrome).
b-Malignant obstruction of CBD without G.B. enlargement:
1.Associated chronic cholecystitis.
2.Malignancy at the porta hepatis.
#Surgery
a-Calcular obstruction of CBD with palpable G.B. :
1.Metabolic stone with a healthy distensible G.B.
2.Stone in CBD & another stone in cystic duct .
3.A stone of Hartmann's pouch obstructing both cystic duct and CBD (Mirrizi syndrome).
b-Malignant obstruction of CBD without G.B. enlargement:
1.Associated chronic cholecystitis.
2.Malignancy at the porta hepatis.
#Surgery
-Fever and tachycardia are commonly absent in acute cholecystitis; maintain
a high index of clinical suspicion!
#Surgery
a high index of clinical suspicion!
#Surgery
- Most Common organ injured in blunt abdominal trauma is the spleen ( the second is the liver).
-Most Common organ injured in penetrating abdominal trauma is the small intestine.
-Blunt truma patient with hemodynamic instability should be evaluated by USG ( FAST).
-FAST =( Focused assessment with Sonography for Trauma)
👇🏽
-Rapid diagnostic examination to assess patients with potential thoracoabdominal injuries , performed within 2 - 4 minutes
#Surgery
-Most Common organ injured in penetrating abdominal trauma is the small intestine.
-Blunt truma patient with hemodynamic instability should be evaluated by USG ( FAST).
-FAST =( Focused assessment with Sonography for Trauma)
👇🏽
-Rapid diagnostic examination to assess patients with potential thoracoabdominal injuries , performed within 2 - 4 minutes
#Surgery
•Redness more dangerous than cynosis in ischaemic limb, Why?
-Because redness means extravasation of blood form dead. tissues.
#Surgery
-Because redness means extravasation of blood form dead. tissues.
#Surgery
-Crystalloids include saline, Ringer’s lactate, and glucose.
-Colloids include blood products such as red blood cells (RBCs) and albumin.
#Surgery
-Colloids include blood products such as red blood cells (RBCs) and albumin.
#Surgery
ERCP Complications:
2B 2P
2B
1-Bleeding
2-Bacterial cholangitis.
2P
1-Perforation
2-Pancreatitis.
#Surgery
2B 2P
2B
1-Bleeding
2-Bacterial cholangitis.
2P
1-Perforation
2-Pancreatitis.
#Surgery
Features of compartment syndrome:
The 6 Ps
-Pain
-Pallor
-Paresthesias
-Pulse deficit
-Poikilothermia
-Paralysis.
#Surgery
The 6 Ps
-Pain
-Pallor
-Paresthesias
-Pulse deficit
-Poikilothermia
-Paralysis.
#Surgery
Rule in RTA:
-Any unconscious patient should be considered as having spinal cord injury untill proved otherwise.
#Surgery
-Any unconscious patient should be considered as having spinal cord injury untill proved otherwise.
#Surgery