-Decrease serum calcium level is worst prognostic indicator of pancreatitis.

-Open surgery is the gold standard for infected pancreatic necrosis.

-Spiral CT (CECT–contrast enhanced CT) is better—gold standard.

-Serum lipase more specific than amylase.

-Serum lipase level after rise persists for longer period than amylase.

-Serum lactescence (related to triglyceride met abolism)—Most specific in hereditary hyperlipidaemia or alcohol pancreatitis.

-In Acute Pancreatitis: Sudden onset of upper abdominal pain which is referred to back. Pain is severe, agonizing and refractory. Pain may be relieved or reduced by leaning forward.

#Surgery

Radiological features helpful in diagnosis of development hip dysplasia

◼️Shenton's line, a curved line along the inferior edge of the superior pubic ramus in continuity with the femur (see above), in DDH this line is interrupted.

◼️Hilgenreiner line, a horizontal line taken through both triradiate cartilages (see above).

◼️Perkin's line, this is a vertical line perpendicular on the Hilgenreiner line drawn from the lateral edge of the triradiate cartilage, this intersection will form 4 quadrants, normally the femoral head should lie in the lower inner quadrant, whereas in DDH the femoral head lies in the upper outer quadrant.

#Surgery

Complications of splenectomy

◼️Bleeding, may occur due to slipped ligature on the splenic artery, this can cause rapid exsanguination.

◼️Injury to surrounding organs, tail of the pancreas can be injured resulting in (1)Acute pancreatitis, (2)Pancreatic abscess, (3) Pancreatic fistula, injury to the stomach can cause hematemesis, also injury to the greater curve during ligation of short gastric vessels can cause gastric fistula, acute gastric dilatation may also occur.

◼️Infection, such as wound infection or a left subphrenic abscess.

◼️Pulmonary complications, including left basal atelectasis and pleural effusion.

◼️Overwhelming post-splenectomy infections by encapsulated organisms including pneumococci, meningococci, and H.influenzae, viral influenza infections can predispose to these bacterial infections so annual influenza vaccine should be considered.

◼️Thrombocytosis, this can cause thromboembolic manifestations, if the count reach more than 1 million per microlitre, aspirin should be given.

#Surgery

Signs of vascular trauma

◼️This is an essential part to recognize, a trauma to an artery may lead to acute spasm, or formation of a subintimal hematoma or acute thrombosis, all may occlude the vessel, alternatively a trauma may cause laceration of the vessel either completely or partially, remember: Partial laceration causes more bleeding than complete laceration.

◼️The HARD SIGNS of vascular trauma include (1) Pulsatile bleeding, (2) Pulsatile hematoma, (3) Signs of acute limb ischaemia, (4) Thrill or bruit due to traumatic AV fistula or a false aneurysm, (5) Rapidly Expanding hematoma.

◼️Soft signs include (1) Non pulsatile stable hematoma, (2) Unexplained shock or falling hemoglobin, (3) Injury at an anatomical site of an artery, (4) Evidence of nerve injury in proximity to an artery, (5) History of significant hemorrhage at time of trauma and before presentation.

#Surgery

Indications of mastectomy in early breast cancer rather than wide local excision followed by radiotherapy are:

1) Large tumour in relation to the size of the breast.
2) Central tumour below or involving the nipple.
3) Multifocality/ Multicentricity.
4) Patient's preference.
5) Local recurrence.

#Surgery

"AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen".

"OTA" is for "Orthopaedic Trauma Association" Committee.

Complications of Chronic Osteomyelitis:

i. Acute excacerbation
ii. Growth abnormalities due to damage to adjacent growth plate
iii. Pathological fracture
iv. Joint stiffness
v. Sinus tract malignancy (very rare): Squamous cell carcinoma
vi. Amyloidosis.

#Surgery

The Important Complications of Acute Osteomyelitis are:

i. Septicemia and pyaemia
ii. Septic arthritis
iii. Chronic osteomyelitis (most common complication)
iv. Metastatic infection to other body parts
v. Pathological fracture
vi. Altered growth from damage to epiphyseal growth plate.
vii. Recurrence.

#Surgery

Any shaft fracture in body, use AO classification:

For example:
Bone =femur=3
Segment =2 "diaphysis or shaft"

A simple fracture
B wedge fracture
C complex fracture.

#Surgery

Both radius and ulna shaft fractures classification:

A simple fracture
B wedge fracture
C complex fracture.

Distal humeral /femoral fracture classification:

Type A: Extra-articular "supracondylar in distal humeral #"
Type B: Partial articular "unicondylar"
Type C: Complete articular "bicondylar"

#Surgery

Stages of Impingement syndrome:

Stage I: edema and inflammation
Reversible lesion
Positive Neer impigement
Tenderness over GT

Stage II: Fibrosis and tendinitis
Not reversible
As S I plus:
Crepitus of soft tissue
Catching sensation at lowering shoulder

Stage III: Bone spur and tendon rupture
Not reversible
Like II and I

#Surgery

Phases of Adhesive capsulitis "Frozen shoulder":

1-Painful phase: Synovitis
2-Adhesive phase: fibrosis
3-Resolution phase: obliteration and contraction of GH joint space.

#Surgery

4&5 in symptoms, they are not symptoms, but are signs.

Clinical presentation of Breast cancer.

#Surgery

CT indications in Head injury.

#Surgery

Whipple's operation:

It is done for treatment of pancreas adenocarcinoma.
It contains removal of head and neck of the pancreas, whole duodenum, antrum of stomach, GB and CBD.
Then anastomoses: hepatic and pancreatic ducts and stomach to the jejunum.

#Surgery