USG neck to differentiate in thyroid:
• Cystic or solid swelling
• Multinodular or solitary nodular
• To find nodes.
#Surgery
• Cystic or solid swelling
• Multinodular or solitary nodular
• To find nodes.
#Surgery
Any unconscious patient after trauma should be considered having neck bone fracture until proved otherwise.
#Surgery
#Surgery
•Best diagnostic test in stable patient with blunt trauma abdomen is👉🏼CECT.
BUT
•Investigation of choice for blunt trauma abdomen in unstable patient👉🏼USG.
•Investigation of choice for diagnosing intra abdominal bleeding in an unstable patient👉🏼USG.
•Patient of penetrating injury to the abdomen with shock, next best step is👉🏼Laparotomy
•If Diagnostic peritoneal lavage is positive, do directly 👉🏼 Laparotomy.
•Most commonly injured in the blunt trauma is 👉🏼Spleen,"In recent study,liver"
•Most commonly injured in penetrating trauma is 👉🏼Small intestine.
#Surgery
BUT
•Investigation of choice for blunt trauma abdomen in unstable patient👉🏼USG.
•Investigation of choice for diagnosing intra abdominal bleeding in an unstable patient👉🏼USG.
•Patient of penetrating injury to the abdomen with shock, next best step is👉🏼Laparotomy
•If Diagnostic peritoneal lavage is positive, do directly 👉🏼 Laparotomy.
•Most commonly injured in the blunt trauma is 👉🏼Spleen,"In recent study,liver"
•Most commonly injured in penetrating trauma is 👉🏼Small intestine.
#Surgery
•What is the most dangerous type of appendicitis ? Why ?
-Post-ileal type is considered the most dangerous type, because :
1. No shift of pain which is misdiagnosed as gastroenteritis
2. No omental localization👉🏼peritonitis
3. Affection of iliocaecal vein 👉🏼 portal pyemia
4. Affection of appendicular artery👉🏼gangrene.
#Surgery
-Post-ileal type is considered the most dangerous type, because :
1. No shift of pain which is misdiagnosed as gastroenteritis
2. No omental localization👉🏼peritonitis
3. Affection of iliocaecal vein 👉🏼 portal pyemia
4. Affection of appendicular artery👉🏼gangrene.
#Surgery
•If the patient has bilateral inguinal hernias ,how would you proceed? And which side to operat first?
-We will repair one side only and then the other side after 6 months.
-This is to avoid over stretching the abdominal muscles if both sides were repaired in the same time..!
•We usually started by:
a. The bigger hernia.
b. That with narrower neck.
c. The more painful side.
#Surgery
-We will repair one side only and then the other side after 6 months.
-This is to avoid over stretching the abdominal muscles if both sides were repaired in the same time..!
•We usually started by:
a. The bigger hernia.
b. That with narrower neck.
c. The more painful side.
#Surgery
In thyroid surgery:
-The platysma has to be closed with the SC tissue as a separate layer to avoid adherent ugly scar.
-Morphine & hyoscine,(Instead of atropine in toxic cases as atropine causes tachycardia).
-Artery is ligated before vein to avoid lobe congestion.
#Surgery
-The platysma has to be closed with the SC tissue as a separate layer to avoid adherent ugly scar.
-Morphine & hyoscine,(Instead of atropine in toxic cases as atropine causes tachycardia).
-Artery is ligated before vein to avoid lobe congestion.
#Surgery
Common sites of injury to RLN:
–Near inferior thyroid artery
–Near ligament of berry
–At inferior pole of the gland.
#Surgery
–Near inferior thyroid artery
–Near ligament of berry
–At inferior pole of the gland.
#Surgery
-If FNAC shows follicular adenoma; lobectomy is enough because 80 percent of cases are benign.
-If the biopsy report becomes positive for malignancy based on angio or capular invasion: Completion total thyroidectomy must be done.
#Surgery
-If the biopsy report becomes positive for malignancy based on angio or capular invasion: Completion total thyroidectomy must be done.
#Surgery
In Thyroid tumors:
1.History of irradiation—papillary carcinoma.
2.History of longstanding multinodular goiter—follicular carcinoma.
3.Family History—medullary carcinoma thyroid.
4.Hashimotos thyroiditis—lymphoma and papillary carcinoma.
5.Thyroglossal cyst—papillary carcinoma.
#Surgery
1.History of irradiation—papillary carcinoma.
2.History of longstanding multinodular goiter—follicular carcinoma.
3.Family History—medullary carcinoma thyroid.
4.Hashimotos thyroiditis—lymphoma and papillary carcinoma.
5.Thyroglossal cyst—papillary carcinoma.
#Surgery
-FNAC is the DIAGNOSTIC test of choice for thyroid nodule.
-Multinodular goiter is the most common cause of thyroid enlargement.
#Surgery
-Multinodular goiter is the most common cause of thyroid enlargement.
#Surgery
Remember 6P
•Papillary cancer
-Popular (most common)
-Psammoma bodies
-Palpable lymph nodes (spreads most commonly by lymphatics, seen in 33% of patients)
-Positive 131I uptake
-Positive prognosis
-Postoperative 131I scan to diagnose treat metastases
-Pulmonary metastases.
•Acute limb ischemia
-Pain
-Pallor
-Pulselessness
-Paralysis
-Paresthesia
-Poikilothermia.
#Surgery
•Papillary cancer
-Popular (most common)
-Psammoma bodies
-Palpable lymph nodes (spreads most commonly by lymphatics, seen in 33% of patients)
-Positive 131I uptake
-Positive prognosis
-Postoperative 131I scan to diagnose treat metastases
-Pulmonary metastases.
•Acute limb ischemia
-Pain
-Pallor
-Pulselessness
-Paralysis
-Paresthesia
-Poikilothermia.
#Surgery
-The histologic finding that defines malignancy in follicular cancer is Capsular or blood vessel invasion,so that FNAC isn't useful.
-The most common site of distant metastasis is Bone.
-Total thyroidectomy is the treatment.
#Surgery
-The most common site of distant metastasis is Bone.
-Total thyroidectomy is the treatment.
#Surgery
Medullary cancer:
-MENII
-aMyloid Median lymph node dissection
-Modified neck dissection if lateral nodes are positive.
#Surgery
-MENII
-aMyloid Median lymph node dissection
-Modified neck dissection if lateral nodes are positive.
#Surgery