Mondor's Disease

◼️The above image is a mondor's disease under the right breast.

◼️It is a thrombophlebitis of the superficial veins of the breast and anterior chest, also reported to involve the arm.

◼️In absence of infection or injury, the cause of this disease is obsecure.

◼️The Pathognomonic feature, is a thrombosed subcutaneous cord of vein usually attached to the skin, when the skin overlying the breast is stretched, a narrow shallow groove appear along side the cord.

◼️Differential diagnosis include lymphatic permeation from an occult breast carcinoma.

◼️No treatment other than restricting arm movement is needed, it resolve on its own in few months without complication, recurrence or deformity.

◼️Some case reports suggested association of mondor's Disease with breast cancer, although this is probably a coincidental event.

#Breast

TNM staging and Manchester staging of breast cancer.

#Surgery

Manchester staging of Breast cancer:

Stage I:
-Mobile tumour in the breast; no deeper fixation; skin if involved lesser the size of the tumour; lymph node spread is absent.

Stage II:
-Same as stage 1 with mobile discrete axillary nodes.

Stage III:
-Fixed to pectoralis major or skin involvement more the tumour size or fixed/adherent node.

Stage IV:
-Tumour fixed to chest wall, involvement same or opposite supraclavicular nodes, opposite axillary nodes, opposite breast, cancer en cuirasse, distant blood spread.

Note:
-Manchester staging and Columbia classification are obsolete (not used now).

#Surgery

Glasgow vs Ranson criteria in AP.

#Surgery

Indications for surgery in AAA:
-Asymptomatic aneurysm more than 5.5 cm.
-Growth rate more than 0.5 cm/year.
-Painful, tender aneurysm.
-Thrombosed aneurysm, aneurysm with distal emboli.

Indications for surgery in PAD:
-Claudication.
-Rest pain.
-Ischemic ulceration.

•ACUTE GASTRIC DILATATION

-It is an enormous acute dilatation of stomach with atonic gastric wall without peristalsis.
-Stomach distends enormously occupying most of the abdomen and pelvis causing sequestration of lots of fluid resulting in hypovolaemia.

#Surgery
#Stomach

•Causes of Acute Gastric dilatation:

1-After major surgery (abdomen,. neurosurgery).
2-Trauma, burns.
3-Retroperitoneal haematoma.
4-Electrolyte imbalance.
5-Other causes: Anorexia nervosa, bulimia, polyphagia, drug abuse, diabetes, anaesthesia, debilitating diseases, spinal cord diseases, muscle dystrophy.

#Surgery
#Stomach

•HYPERTROPHIC PYLORIC STENOSIS

-There is increased risk of developing the condition if new- born gets erythromycin or azithromycin in first 14 days after birth.

#Medicine
#Pediatrics

•Ultrasound abdomen (very useful) in PS:

-Doughnut sign.
-Pyloric muscle 4 mm or more in thickness.
-Length of pyloric canal >14 mm.
-Cervix sign on long avis, target sign on short axis.

#Medicine
#Pediatrics

•Precancerous lesions of Gastric Cancer:

1•H. pylori infection, chronic gastritis
2•Pernicious anaemia
3•Intestinal metaplasia
4•Adenomatous polyps more than 2 cm
5•Agammaglobulinaemia
6•Benign gastric ulcer
7•Previous gastric surgery
8•Stomach remnant (stump carcinoma)
9•Menetrier’s disease.
10•Benign gastric ulcer.

#Surgery
#Medicine

DUODENAL BLOW-OUT 5%:

-It is a very serious complication of Billroth II gastrectomy, occurs usually on 4–5th day after surgery.

#Surgery
#Stomach

DUMPING SYNDROME(Post-cibal Syndrome):

-It is common in females, seen after Billroth II surgery.

#Surgery
#Stomach

•EARLY DUMPING SYNDROME:

-It is common and more severe type Incidence is 10% Vasomotor symptoms appear immediately after food, lasts for 30-40 minutes, aggravated by bulky food.
-It is relieved by lying down, aggravated by more food.

-Clinical features: Sweating, tachycardia, colicky pain and diarrhoea, Hypotension and features of hypovolaemia.

#Surgery
#Stomach

•LATE DUMPING SYNDROME:

-It is of less severe type Incidence is 5% It usually occurs 2 hours after meal.
-It is relieved by glucose and aggravated by exercise.

-Pathogenesis: Due to initial hyperglycaemia insulin secretion is stimulated which in turn leads to hypoglycaemia.

-Clinical features: Tremor, fainting, nausea, Features of hypoglycaemia.

-Treatment: Symptoms are less severe and so treated conservatively, by giving glucose and food.

#Surgery
#Stomach

•Mackler triad (esp. in Boerhaave syndrome) in Esophageal Perforation:

1-Vomiting and/or retching
2-Severe retrosternal pain that often radiates to the back
3-Subcutaneous or mediastinal emphysema:
crepitus in the suprasternal notch and neck region or crunching/crackling sound on chest auscultation (Hamman sign).

#Surgery

•Extra-esophageal symptoms (respiratory )of GERD:

1-Reflux-induced Asthma.
2-Chronic Cough.
3-Aspiration pneumonia.
4-Recurrent laryngitis.
5-Pulmonary fibrosis.
6-Hiccups.
7-Pharyngeal & laryngeal irritation horsiness of voice.
8-Otitis media.

#Medicine

•Complications of Barrett’s oesophagus:

1-Ulcerations and stricture
2-Dysphagia
3-Bleeding
4-Perforation
5-Adenocarcinoma of O-G junction (25 times more common).

#Surgery

•In Esophageal Carcinoma:

-It is 6th most common cancer in the world.
-It is less than 1% of all cancers.
-It is 7% of all GI malignancies.
-Common in:
Middle third—50%.
Lower third—33%.
Upper third—17%.

-Recent onset of dysphagia is the commonest feature.

#Surgery
#GIT

•Helicobacter pylori infection, which can cause stomach cancer, has not been associated with esophageal cancer.

#Surgery

•Whipple's triad

-Typical presentation of insulinomas.
Consists of :

1-Symptomatic fasting hypoglycemia.

2-Plasma glucose less than 50 mg/dl during the attack .

3-Dramatic improvement after administration of glucose.

#Medicine
#Endocrine