-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).
#Surgery
-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
PAIN
🔻Pain is an unpleasant sensation of varying intensity.
🔻It is one of nature’s ways of warning us that something is going wrong in our body.
🔻Pain is a commonest symptom which patient complains to a clinician, in surgery.
🔻It comes from Latin word ‘poena’ means penalty or punishment.
🔻The two most significant properties of an abdominal pain are its site and its character.
🔻Tenderness is pain induced by a stimulus, such as pressure from the doctor’s hand, or forced movement.
🔻Pain is the one patient feels, while tenderness (sign) is the one surgeon or clinician elicits.
🔻Tenderness can be both a symptom and a physical sign!
🔻Rebound tenderness:
-"Release Sign, Blumberg’s Sign": is an abrupt increase in pain when an examiner suddenly releases compression of the abdominal wall.
-Caused by irritation of the receptors in parietal peritoneum.
#Surgery
🔻Pain is an unpleasant sensation of varying intensity.
🔻It is one of nature’s ways of warning us that something is going wrong in our body.
🔻Pain is a commonest symptom which patient complains to a clinician, in surgery.
🔻It comes from Latin word ‘poena’ means penalty or punishment.
🔻The two most significant properties of an abdominal pain are its site and its character.
🔻Tenderness is pain induced by a stimulus, such as pressure from the doctor’s hand, or forced movement.
🔻Pain is the one patient feels, while tenderness (sign) is the one surgeon or clinician elicits.
🔻Tenderness can be both a symptom and a physical sign!
🔻Rebound tenderness:
-"Release Sign, Blumberg’s Sign": is an abrupt increase in pain when an examiner suddenly releases compression of the abdominal wall.
-Caused by irritation of the receptors in parietal peritoneum.
#Surgery
🔻Radiation of pain:
-It is the extension of the pain to another site while the initial pain persists.
-Radiating pain is of same character of original site.
-For example, penetration of duodenal ulcer posteriorly causes pain both in epigastrium and back.
-Pain of pancreatitis radiates to back.
#Surgery
-It is the extension of the pain to another site while the initial pain persists.
-Radiating pain is of same character of original site.
-For example, penetration of duodenal ulcer posteriorly causes pain both in epigastrium and back.
-Pain of pancreatitis radiates to back.
#Surgery
🔻Referred pain:
-It is pain that is felt at a distance from its source. It's not felt at the site of the disease.
-For example, inflammation of the diaphragm causes a pain experienced only at the tip of the shoulder.
-Hip joint pathology may cause referred pain in knee joint.
-Referred pain in the epigastrium from the heart; referred pain in the abdomen from pleura; referred pain over the testis from the ureter..etc
-Referred pain is caused by the inability of the central nervous system to distinguish between visceral and somatic sensory impulses.
#Surgery
-It is pain that is felt at a distance from its source. It's not felt at the site of the disease.
-For example, inflammation of the diaphragm causes a pain experienced only at the tip of the shoulder.
-Hip joint pathology may cause referred pain in knee joint.
-Referred pain in the epigastrium from the heart; referred pain in the abdomen from pleura; referred pain over the testis from the ureter..etc
-Referred pain is caused by the inability of the central nervous system to distinguish between visceral and somatic sensory impulses.
#Surgery
🔻Shifting/migration of pain:
-Origin of pain is in one site; later pain shifts to another site and pain at original site disappears.
-Pain when begins in viscera, is felt at the same somatic segmental area in the body; but once parietal layer is involved by inflammation/ pathology pain is felt at the anatomical site.
-Common example is that of acute appendicitis.
#Surgery
-Origin of pain is in one site; later pain shifts to another site and pain at original site disappears.
-Pain when begins in viscera, is felt at the same somatic segmental area in the body; but once parietal layer is involved by inflammation/ pathology pain is felt at the anatomical site.
-Common example is that of acute appendicitis.
#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).
#Surgery
-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