What are the preoperative preparations required in incisional hernia?

•Weight reduction by dieting and exercise.
•Patient is asked to stop smoking
•Treat the respiratory problems or BBH.

#Hernia
#Surgery

•What is ventral hernia?

-The term ventral hernia should be restricted to incisional hernia arising in abdominal midline operative wounds.

#Hernia
#Surgery

-What is the most important clinical sign for incisional hernia?

•The swelling will be come more prominent in head raising test. •Reducibility and cough impulse.

#Hernia
#Surgery

•If the lump does not reduce and does not have a cough impulse, what are the differential diagnoses in incisional hernia?

-Then it may not be a hernia.

-The following differential diagnoses are to be considered:
-Differential diagnoses if it is not reducible
•Deposit of tumor—Desmoid tumor •Hematoma
•Foreign-body granuloma
•Old abscess
•Lipoma.

#Hernia
#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

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

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

Sure signs of fracture:

1-Deformity.
2-Length discrepancy.
3-Abnormal movement.
4-Crepitus.

#Surgery

Post-operative return of GI function:

-Small bowel: 12-24h.
-Stomach: 24-48h.
-Large bowel: 48-72h.

#Surgery

Stages of bone healing:

1- Hematoma 👉🏼0-3 wk
2-Callus+Osteoclast 👉🏼3-6wk
3-Bone formation in callus 👉🏼6-12wk
4-Cortical gap is bridged by bone 👉🏼6-12 m
5-Remodelling"Normal architecture"👉🏼1-2 yr.

-Tornoto notes
#Surgery

Stages of Appendicitis:

1-Catarrhal
2-Edematous
3-Phlegmonous
4-Gangrenous
5-Perforated.

#Surgery

-Ascitic fluid less than 500 cc cannot be detected clinically.

-Minimal Ascites (500-1000cc).
-Moderated Ascites (1000-2000cc).
-Severe Ascitis (>2000 cc)

•Moderate amount: Shifting dullness.
•Tense: transmitted thrill.
•Minimal: knee - elbow.

#Surgery

Remember:

Important lymph nodes.

#Surgery

Orthopaedics instruments.

#Surgery

An example of Orthopaedics history and examination.

#Surgery

Remember:

-In hypospadias, circumcision is contraindicated as prepucial skin is required for future urethroplasty.

#Surgery

Remember:

-Fracture pain is sharp and stabbing in its character, aggravated by attempted movement, and relieved by rest and splintage.

-Muscle pain is often described as ‘stiffness’ or aching, and is aggravated by use of the affected muscle(s).

#Surgery

Remember:

Fav for MCQ's

-The most common cause of death in DM is IHD
-The most common cause of death in Guillain-Barré syndrome is cardiac arrhythmia "Update" previously was Respiratory Failure.
-MC cause of death in Sarcoidosis is RHF" Cor pulmonale"

#Medicine

Remember:

-MC cause of death in Systemic sclerosis is PAH but some say it is ILD.
-MC cause of death in Rheumatoid arthritis is Coronary artery disease.
-MC cause of death in SLE is infections. Renal impairment.
-MC cause of death in Hemochormoatosis is HCC.

#Medicine