Mercedes benz sign or seagull sign, caused by gas in a triradiant or biradiant manner inside the centre of a gallstone, above figure shows this sign.
#Surgery
#Surgery
Sure signs of fracture:
1-Deformity.
2-Length discrepancy.
3-Abnormal movement.
4-Crepitus.
#Surgery
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
-Small bowel: 12-24h.
-Stomach: 24-48h.
-Large bowel: 48-72h.
#Surgery
Post-operative History:
History taking:
•Ask about the following points and repeat them every day starting from day 0 (day of operation):
-Fever
-Nausea and vomiting (causes: pain, opioids analgesics, paralytic ileus, and anesthesia).
-Oral intake: solid and liquid.
-Cough/sputum (causes: anesthesia, chest infection).
-Dyspnea.
-Chest pain.
-Pain at site of operation: excessive pain maybe caused by wound infection.
-Wound discharge or bleeding.
-Passage of flatus or stool (indicates the return of GIT function).
-Passage of urine.
-Mobility (i.e. does the patient get up and start walking? prolonged immobility is bad - DVT).
-Pain in the legs (may indicate DVT).
-Tubes & Drains: e.g. Foley catheter, nasogastric tube (NG tube), surgical drain.
-Treatment received: Drugs & IV fluids.
#Surgery
History taking:
•Ask about the following points and repeat them every day starting from day 0 (day of operation):
-Fever
-Nausea and vomiting (causes: pain, opioids analgesics, paralytic ileus, and anesthesia).
-Oral intake: solid and liquid.
-Cough/sputum (causes: anesthesia, chest infection).
-Dyspnea.
-Chest pain.
-Pain at site of operation: excessive pain maybe caused by wound infection.
-Wound discharge or bleeding.
-Passage of flatus or stool (indicates the return of GIT function).
-Passage of urine.
-Mobility (i.e. does the patient get up and start walking? prolonged immobility is bad - DVT).
-Pain in the legs (may indicate DVT).
-Tubes & Drains: e.g. Foley catheter, nasogastric tube (NG tube), surgical drain.
-Treatment received: Drugs & IV fluids.
#Surgery
Cont...
Example of post-operative history:
Day 0:
-The patient had cough, sputum, mild pain at the the site of operation. But there was no fever, no nausea or vomiting, no oral intake, no chest pain, no shortness of breath. She passed urine but hasn't passed flatus or stool. No leg pain & hasn't started mobilizing yet. She received IV fluids & IV medications.
Day 1:
-No fever, no nausea or vomiting, no cough, no chest pain or dyspnea, she passed flatus and stool & oral intake was resumed in the form of liquid & soft food (e.g. orange juice & biscuit). The pain is decreased at the site of operation. The patient started walking in the ward and going to bathroom. She received IV fluids & IV medications.
Day 2:
-No fever, no nausea or vomiting, no cough, no chest pain or shortness of breath, mild pain at operation wound, normal oral intake, normal passage of stool and urine, no leg pain and normal mobility.
#Surgery
Example of post-operative history:
Day 0:
-The patient had cough, sputum, mild pain at the the site of operation. But there was no fever, no nausea or vomiting, no oral intake, no chest pain, no shortness of breath. She passed urine but hasn't passed flatus or stool. No leg pain & hasn't started mobilizing yet. She received IV fluids & IV medications.
Day 1:
-No fever, no nausea or vomiting, no cough, no chest pain or dyspnea, she passed flatus and stool & oral intake was resumed in the form of liquid & soft food (e.g. orange juice & biscuit). The pain is decreased at the site of operation. The patient started walking in the ward and going to bathroom. She received IV fluids & IV medications.
Day 2:
-No fever, no nausea or vomiting, no cough, no chest pain or shortness of breath, mild pain at operation wound, normal oral intake, normal passage of stool and urine, no leg pain and normal mobility.
#Surgery
Day 0: It's the day of operation till 12 am.
E.g.,patient has undergone a surgery at 11:00 pm. on Friday, it's called zero day. But when it becomes 12:00 am. Saturday, it became Day 1.
#Surgery
E.g.,patient has undergone a surgery at 11:00 pm. on Friday, it's called zero day. But when it becomes 12:00 am. Saturday, it became Day 1.
#Surgery
Suture removal:
-It should be removed within 1-2 weeks depending on anatomical location
1. Face "nose, ear, lip" ➔ 5-7 days
2. Scalp ➔ 7-10 days, neck-7 days.
3. Trunk & upper extremities ➔ 10-14 days
4. Lower extremities ➔ 14-21 days.
#Surgery
-It should be removed within 1-2 weeks depending on anatomical location
1. Face "nose, ear, lip" ➔ 5-7 days
2. Scalp ➔ 7-10 days, neck-7 days.
3. Trunk & upper extremities ➔ 10-14 days
4. Lower extremities ➔ 14-21 days.
#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
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
Contraindications of Appendicectomy:
1- Appendicular mass
(Oschner-Sherren Regimen).
2-Appendicular abscess
(Extra-peritoneal drainage).
3-Crohn's disease affecting the caecum.(To avoid fecal fistula).
#Surgery
1- Appendicular mass
(Oschner-Sherren Regimen).
2-Appendicular abscess
(Extra-peritoneal drainage).
3-Crohn's disease affecting the caecum.(To avoid fecal fistula).
#Surgery
Morrant Baker’s Cyst:
- It is a cystic swelling containing gel-like fluid in the lower midline of the popliteal fossa. It occurs due to herniation of the synovial membrane of the knee joint as a result of chronic arthritis.
#Surgery
- It is a cystic swelling containing gel-like fluid in the lower midline of the popliteal fossa. It occurs due to herniation of the synovial membrane of the knee joint as a result of chronic arthritis.
#Surgery
Indications of drug therapy in liver hydatid cyst:
-10 days prior to intervention and to continue it for 1 month (albendazole) to 3 months (mebendazole) after the intervention
-Inoperable cysts
-Multiple or multiorgan cysts
-Recurrent hydatids
-Surgically unfit patients
-Cysts in lungs.
•Mebendazole—600 mg daily for 4 weeks.
•Praziquantel—60 mg/kg along with albendazole for 2 weeks.
•Albendazole-400 mg twice daily. 4-week cycles with 2 weeks drug free interval.
N.B.
-Surgery is still the choice and gold standard therapy for hydatid disease.
#Surgery
-10 days prior to intervention and to continue it for 1 month (albendazole) to 3 months (mebendazole) after the intervention
-Inoperable cysts
-Multiple or multiorgan cysts
-Recurrent hydatids
-Surgically unfit patients
-Cysts in lungs.
•Mebendazole—600 mg daily for 4 weeks.
•Praziquantel—60 mg/kg along with albendazole for 2 weeks.
•Albendazole-400 mg twice daily. 4-week cycles with 2 weeks drug free interval.
N.B.
-Surgery is still the choice and gold standard therapy for hydatid disease.
#Surgery
Inspection is done always first in standing straight up without bending later in lying down position, in case of hernia.
#Surgery
#Surgery
•Why do we ask the patient to turn his face to opposite side during Expansile impulse on coughing?
-To prevent coughing towards examiner.
•Pubic tubercle may be reached by following the tendon of adductor longus.
•Taxis is gradual reduction of contents of the scrotum by gentle manipulation by flexion, adduction and rotation of hip joint.
#Surgery
-To prevent coughing towards examiner.
•Pubic tubercle may be reached by following the tendon of adductor longus.
•Taxis is gradual reduction of contents of the scrotum by gentle manipulation by flexion, adduction and rotation of hip joint.
#Surgery
Deep ring occlusion test:
-When deep"internal" ring is occluded after reducing the contents, if impulse on coughing is absent in standing position then it is indirect inguinal hernia; if impulse on coughing is still present then it is direct inguinal hernia.
-It is the most important test in inguinal hernia.
-Deep/internal ring is located 1.25 cm above the mid-inguinal point.
-Midinguinal point is mid-point between the anterior superior iliac spine and pubic symphysis.
#Surgery
-When deep"internal" ring is occluded after reducing the contents, if impulse on coughing is absent in standing position then it is indirect inguinal hernia; if impulse on coughing is still present then it is direct inguinal hernia.
-It is the most important test in inguinal hernia.
-Deep/internal ring is located 1.25 cm above the mid-inguinal point.
-Midinguinal point is mid-point between the anterior superior iliac spine and pubic symphysis.
#Surgery
Silk glove sign:
-Index finger is invaginated across scrotum towards the external ring. When patient coughs, inguinal hernia is felt as a slit-like sensation.
#Surgery
-Index finger is invaginated across scrotum towards the external ring. When patient coughs, inguinal hernia is felt as a slit-like sensation.
#Surgery
Inguinal hernia is commonest type of hernia in females.
Inguinal canal in female is called as canal of Nuck.
#Surgery
Inguinal canal in female is called as canal of Nuck.
#Surgery
Classification of Hernia According to Contents:
•Omentocele—omemtum.
•Enterocele—intestine.
•Cystocele—urinary bladder.
•Litter’s hernia—Meckel’s diverticulum.
•Maydl’s hernia.
•Sliding hernia.
•Richter’s hernia—part of the bowel wall.
•Omentocele—omemtum.
•Enterocele—intestine.
•Cystocele—urinary bladder.
•Litter’s hernia—Meckel’s diverticulum.
•Maydl’s hernia.
•Sliding hernia.
•Richter’s hernia—part of the bowel wall.
•Signs of inflamed appendix during surgery:
1-Peritoneal reaction (serous fluid or pus).
2-Presence of omentum at the wound.
•How to Identify the appendix:
-Follow the taenia coli convergence
towards the appendix.
-The base is at 2.5 cm from iliocaecal junction.
•Crushing with Kocher's forceps:
-To promote haemostasis.
-Speed fibrosis.
-Cause more fixation of the ligature.
#Surgery
1-Peritoneal reaction (serous fluid or pus).
2-Presence of omentum at the wound.
•How to Identify the appendix:
-Follow the taenia coli convergence
towards the appendix.
-The base is at 2.5 cm from iliocaecal junction.
•Crushing with Kocher's forceps:
-To promote haemostasis.
-Speed fibrosis.
-Cause more fixation of the ligature.
#Surgery
•Multiple air-fluid levels appear in plain X-ray abdomen in case of intestinal obstruction, Why?
-Because during vigorous peristalsis, air enters the distal fluid, results in churning, is the reason to caus multiple air-fluid levels.
•80% of intestinal obstruction is in small bowel.
•80% of small bowel obstructions are due to benign cause.
•70-80% of large intestine obstruction is due to malignancy.
•Adhesions (40%) are the commonest cause especially in developed countries.
#Surgery
-Because during vigorous peristalsis, air enters the distal fluid, results in churning, is the reason to caus multiple air-fluid levels.
•80% of intestinal obstruction is in small bowel.
•80% of small bowel obstructions are due to benign cause.
•70-80% of large intestine obstruction is due to malignancy.
•Adhesions (40%) are the commonest cause especially in developed countries.
#Surgery