Surgical site infection: "SSI"
-Infection arising within 30 days of a surgical procedure at the site of the surgical incision, and within 1 year in the presence of the implant.
Types of SSI
1-Incisional SSI
a-Superficial:
-SSI involving only the skin and subcutaneous tissue of the incision.
b-Deep:
-It involves fascia and muscle layers.
2-Organ/space SSI
-SSI involving any part of the body that is deeper than the fascia or muscle layers.
#Surgery
-Infection arising within 30 days of a surgical procedure at the site of the surgical incision, and within 1 year in the presence of the implant.
Types of SSI
1-Incisional SSI
a-Superficial:
-SSI involving only the skin and subcutaneous tissue of the incision.
b-Deep:
-It involves fascia and muscle layers.
2-Organ/space SSI
-SSI involving any part of the body that is deeper than the fascia or muscle layers.
#Surgery
Important clinical pointers:
Under the setting of infantile obstruction of the gut
Infant with dribbling saliva = esophageal atresia until proven other wise.
Infant with vomitting and a lump =Hypertrophic pyloric stenosis until proven otherwise.
Infant with vomitting and no lump and no salivary dribbling = Duodenal atresia until proven otherwise.
#Surgery
Under the setting of infantile obstruction of the gut
Infant with dribbling saliva = esophageal atresia until proven other wise.
Infant with vomitting and a lump =Hypertrophic pyloric stenosis until proven otherwise.
Infant with vomitting and no lump and no salivary dribbling = Duodenal atresia until proven otherwise.
#Surgery
The commonest position of appendix is retrocaecal (74%),Why?
- This is because during childhood the continous growth of the caecum rotates the appendix behind it how ever it will always remain intraperitoneal.
#Surgery
- This is because during childhood the continous growth of the caecum rotates the appendix behind it how ever it will always remain intraperitoneal.
#Surgery
Barium enema in intussusception :
Charactaristically shows the Claw sign, here barium contrast enters the large bowel and become faced by the negative shadow of the intussusception mass giving rise to these outlines appearing as a claw, it is found in ileocolic and colocolic types, and it is negative in ileoilial type in presence of competent ileocecal valve which blocks the flow of barium into the small bowel, in such cases CT scan is useful for furthur diagnostic evaluation.
#Surgery
Charactaristically shows the Claw sign, here barium contrast enters the large bowel and become faced by the negative shadow of the intussusception mass giving rise to these outlines appearing as a claw, it is found in ileocolic and colocolic types, and it is negative in ileoilial type in presence of competent ileocecal valve which blocks the flow of barium into the small bowel, in such cases CT scan is useful for furthur diagnostic evaluation.
#Surgery
Constipation is one of the cardinal features of intestinal obstruction, but it is not present in :
1)Richter hernia.
2)Gallstone obstruction.
3)Incomplete obstruction.
4)Obstruction due to pelvic abscess.
5)Mesentric vascular occlusion.
#Surgery
-B&L
1)Richter hernia.
2)Gallstone obstruction.
3)Incomplete obstruction.
4)Obstruction due to pelvic abscess.
5)Mesentric vascular occlusion.
#Surgery
-B&L
Physical findings in intussusception:1) Abdominal lump, can be palpated in 50% to 60% of cases, this lump is hardened and feel like a sausage, the concavity being towards the umbilicus.
2)Sensation of emptiness in the right iliac fossa, known as the Dance sign, it result from upward inversion of the caecum as a result of invaginating ileum.
3)Rectal examination may reveal blood stained mucus, the so called red currant jelly, it is also possible in extensive ileocolic or colocolic variety, that the apex is palpable, or even protrude through the anus.
#Surgery
What is the most important aspect to examine in a case of intestinal obstruction?
IT IS VITAL to distinguinsh between strangulated and non strangulated obstruction.
In strangulated obstruction the blood supply to the involved bowel is compromised, this is a surgical emergency and justify early laparotomy.
In non strangulated obstruction the blood supply is not compromised and this can be initially managed conservatively.
-Diagnosing strangulation:
This is ENTIRELY clinical, strangulation is present if :
•There is tenderness and rigidity
In case of intestinal obstruction the presence of any localised tenderness is greatly significant, it is noteworthy that in non strangulated obstruction there may also be tenderness over the area of obstruction, but in strangulated variety there will always be tenderness accompained by rigidity and rebound tenderness.
•Shock
Strangulation causes compromised viability of the bowel wall, this facilitate translocation of the enteric bacteria with systemic exposure, sepsis and shock ensues.
•Pain
The pain of strangulation is very severe, it is differentiated from the usual pain of intestinal obstruction itself, by the fact that this pain is never incomplete or interrupted by periods of abscence,, this pain is constant and remains so despite conservative management.
#Surgery
IT IS VITAL to distinguinsh between strangulated and non strangulated obstruction.
In strangulated obstruction the blood supply to the involved bowel is compromised, this is a surgical emergency and justify early laparotomy.
In non strangulated obstruction the blood supply is not compromised and this can be initially managed conservatively.
-Diagnosing strangulation:
This is ENTIRELY clinical, strangulation is present if :
•There is tenderness and rigidity
In case of intestinal obstruction the presence of any localised tenderness is greatly significant, it is noteworthy that in non strangulated obstruction there may also be tenderness over the area of obstruction, but in strangulated variety there will always be tenderness accompained by rigidity and rebound tenderness.
•Shock
Strangulation causes compromised viability of the bowel wall, this facilitate translocation of the enteric bacteria with systemic exposure, sepsis and shock ensues.
•Pain
The pain of strangulation is very severe, it is differentiated from the usual pain of intestinal obstruction itself, by the fact that this pain is never incomplete or interrupted by periods of abscence,, this pain is constant and remains so despite conservative management.
#Surgery
80% of patients of primary sclerosing cholangitis have ulcerative colitis.Only 4% of patients of UC may have primary sclerosing cholangitis.
#Surgery
#Surgery
Thyrotoxicosis factitia:
-Due to consumption of excess thyroxine
Jod Basedow’s thyrotoxicosis:
-Due to excess iodide consumption.
Wolf-Chaikoff effect:
-Iodides given inhibits the thyroxine and leads to hypothyroidism.
#Surgery
-Due to consumption of excess thyroxine
Jod Basedow’s thyrotoxicosis:
-Due to excess iodide consumption.
Wolf-Chaikoff effect:
-Iodides given inhibits the thyroxine and leads to hypothyroidism.
#Surgery