Quick Notes
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When to stop the drugs before surgery in thyroid operation?

If the patient is posted for surgery tomorrow morning

1.Stop carbimazole today night
2.Stop Lugol’s iodine today night
3.Propranolol to be given tomorrow morning also.

After surgery:

1.Stop carbimazole and Lugol’s iodine
2.Continue the propranolol for 7 days to handle the thyroxine released during surgery and to prevent peripheral T4 to T3 conversion.


#Surgery
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Associated Anomalies with undescended testis:

-Epididymal anomalies and patent processus vaginalis upto 90%.

-Renal Anomalies in10% cases (Renal hypoplasia, agenesis,horseshoe kidney, PUJ obstruction)

-Hypospadias.

#Surgery
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Remember:

Development of the Thyroid Gland:
-The thyroid gland begins to develop during the third week as an entodermal thickening in the midline of the floor of the pharynx between the tuberculum impar and the copula.

-By the seventh week, it reaches its final position in relation to the larynx and trachea.

-The thyroid gland develops from a median down growth of a column of cells from the pharyngeal floor between the first and second pharyngeal pouches (subsequently marked by the foramen caecum of the tongue).


#Surgery
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The right supraclavicular node is called Scalene node.

#Surgery
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What is the bone that has not articulation with any bone?

-The hyoid bone is a mobile single bone found in the midline of the neck below the mandible and abides the larynx.
-It does not articulate with any other bones.


#Surgery
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INDICATIONS OF CBD EXPLORATION:

1. History of charcot’s triad
2. USG proven stones in CBD
3. Dilated CBD (>1cm)
4. OTCshows filling deffect
5. Palpable stones in CB.

#Surgery
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Amount of secretions of gut.

#Medicine
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Stomas.

#Surgery
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Stoma examination.

#Surgery
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Why is indirect inguinal hernia more common in right side ?

Due to delayed descend of right testis , slower closure of a patent processus vaginalis on the right side compared to the left.

It's almost about one month difference.

#Surgery
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Coverings of Testis:

1. Skin
2. Dartos muscle
3. Colle's fascia
4. External spermatic fascia
5. Cremasteric muscle & fascia
6. lnternal spermatic fascia
7. Tunica vaginalis (parietal & visceral layers).
8. Tunica albuginea (fibrous capsule).

#Surgery
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Remember:

-Hasselbach's triangle is also called triangle of Halshted, inguinal triangle.

#Surgery
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Nerve Suoply of GB:

1)Autonomic:-
Parasympathetic: hepatic branch of anterior vagus.
Sympathetic: from T7-9 (pain is reffered to inferior angle of right scapula).

2)Sensory:
-By the Right phrenic C3,4,5 (the same segments as the supra-clavicular nerves ) so pain in gall bladder is referred to right shoulder).

#Surgery
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What are the types of Direct inguinal hernia?

1-Medial
2-Lateral

#Surgery
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Remember:

-The ilioinguinal nerve is a branch of the first lumbar nerve (L1)

-Innervates Skin over the root of the penis and upper part of the scrotum (male), skin covering the mons pubis and labium majus (female).

-Motor innervation of the transverse abdominus and obliques.

#Surgery
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Remember:

-The Adductor canal is also called Hunter's canal or Sub-sartorial canal.

#Surgery
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Sciatic nerve.

#Surgery
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Femoral triangle.

#Surgery
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Femoral sheath.

#Surgery
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Femoral canal.
F. ring and S. opening.

#Surgery
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Adductor canal, popliteal fossa.

#Surgery