•Why the healing of fracture in children is more rapidly and takes short time?
-Because the periosteum is thick has very rich blood supply and growth cells.
#Surgery
-Because the periosteum is thick has very rich blood supply and growth cells.
#Surgery
How do you know that the appendix has been raptured ?
Simply
1. Generalized abdominal pain
2. Gaurdening and rigidity all over the abdomen
3. Shifting dullness ( due to fluid)
4. Diminished the liver dullness on percussion
5. Increase of body temperature (39-40)
6. US : fluid around the appendix and peritoneal cavity
7. CXR: air under diaphragm.
#Appendix
#Surgery
Simply
1. Generalized abdominal pain
2. Gaurdening and rigidity all over the abdomen
3. Shifting dullness ( due to fluid)
4. Diminished the liver dullness on percussion
5. Increase of body temperature (39-40)
6. US : fluid around the appendix and peritoneal cavity
7. CXR: air under diaphragm.
#Appendix
#Surgery
-Fever and tachycardia are commonly absent in acute cholecystitis; maintain
a high index of clinical suspicion!
-Fever is also absent in case of cystitis.
#Surgery
a high index of clinical suspicion!
-Fever is also absent in case of cystitis.
#Surgery
Remember:
In compartment syndrome.
-Pain out of proportion to injury (typically first and most significant symptom).
-Pain with passive stretch (most sensitive sign).
-5Ps:late signs-do not wait for these to develop to make the diagnosis!!
-Tornoto notes
#Surgery
In compartment syndrome.
-Pain out of proportion to injury (typically first and most significant symptom).
-Pain with passive stretch (most sensitive sign).
-5Ps:late signs-do not wait for these to develop to make the diagnosis!!
-Tornoto notes
#Surgery
Quick Notes
This is a polypropylene mesh used for hernioplasty, this provides structural support to a weak defect, it gained widespread popularity especially with inguinal hernias (Lichtenstein tension-free hernioplasty), it can be used for recurrent paraumbilical hernias…
Indications
-Direct hernia.
-Recurrent hernia.
-Re-recurrent hernia.
-Incisional hernia.
-Old age.
-Hernia with weak abdominal muscle tone.
-Sliding hernia.
Complications:
-Infection.
-Mesh extrusion.
-Foreign body reaction.
-Mesh inguinodynia causing hyperaesthesia and pain along the distribution of ilioinguinal or iliohypogastric nerve.
Contraindications:
-In strangulated hernia, Why?
Because the field is potentially infected.
#Surgery
-Direct hernia.
-Recurrent hernia.
-Re-recurrent hernia.
-Incisional hernia.
-Old age.
-Hernia with weak abdominal muscle tone.
-Sliding hernia.
Complications:
-Infection.
-Mesh extrusion.
-Foreign body reaction.
-Mesh inguinodynia causing hyperaesthesia and pain along the distribution of ilioinguinal or iliohypogastric nerve.
Contraindications:
-In strangulated hernia, Why?
Because the field is potentially infected.
#Surgery
Types:
Synthetic:
-Prolene mesh (white in colour)see above.
-Dacron mesh,
-Morlex mesh,
-Mersilene sheath.
Biological:"Not used nowadays".
-Tensor fascia lata,
-Temporal fascia and skin.
#Surgery
Synthetic:
-Prolene mesh (white in colour)see above.
-Dacron mesh,
-Morlex mesh,
-Mersilene sheath.
Biological:"Not used nowadays".
-Tensor fascia lata,
-Temporal fascia and skin.
#Surgery
Types of operations:
-Lichtenstein tension free onlay mesh repair. "most common".
-Nyhus preperitoneal mesh repair.
-Gilbert’s PHS (Prolene Hernia System) repair.
-Gilbert mesh repair (patch and plug).
-Modified Rives preperitoneal mesh repair (Read-Rives).
Now, using laparoscope:
-Transabdominal preperitoneal laparoscopic mesh repair (TAPP repair).
-Totally Extraperitoneal Repair (TEP Repair).
#Surgery
-Lichtenstein tension free onlay mesh repair. "most common".
-Nyhus preperitoneal mesh repair.
-Gilbert’s PHS (Prolene Hernia System) repair.
-Gilbert mesh repair (patch and plug).
-Modified Rives preperitoneal mesh repair (Read-Rives).
Now, using laparoscope:
-Transabdominal preperitoneal laparoscopic mesh repair (TAPP repair).
-Totally Extraperitoneal Repair (TEP Repair).
#Surgery
US Criteria of Acute cholecystitis:
-GB stone
-Biliary sludge "turbid bile"
-Thickened wall
-Strip of fluid" pericholecystitis"
#Surgery
-GB stone
-Biliary sludge "turbid bile"
-Thickened wall
-Strip of fluid" pericholecystitis"
#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
PDS (Polydioxanone synthetic smooth suture):
-Synthetic, absorbable.
-It is monofilamentous,so it is useful in suturing infected or contaminated wounds.
-Time of absorption: 6 months.
-intended for use ingeneral soft tissue approximation, including paediatric CV tissue, microsurgery and ophthalmic surgery.
-Synthetic, absorbable.
-It is monofilamentous,so it is useful in suturing infected or contaminated wounds.
-Time of absorption: 6 months.
-intended for use ingeneral soft tissue approximation, including paediatric CV tissue, microsurgery and ophthalmic surgery.