Remember

Relations to peritoneum:

-Primary retroperitoneal organs include: (from the start of their development) adrenal gland, kidneys, ureter, aorta, IVC, esophagus and rectum.

-Secondary retroperitoneal,Pancreas (except the tail which is intraperitoneal) Duodenum (except the 1st part) Ascending colon &Descending colon.

-Intraperitoneal organs include: stomach, duodenum, liver, spleen, appendix, cecum and transverse colon.

#Anatomy
#Surgery

Remember

-In children younger than 2 - 3 years of age the Cricoid ring " 1st tracheal ring " is the narrowest portion of the airways , while in older children and adults , the glottis is the smallest part .


#Anatomy

MEN syndromes

MEN I :
▪Pituitary adenoma
▪Parathyroid adenoma or hyperplasia
▪Pancreatic tumour.

MEN 2A:
▪Medullary carcinoma of the thyroid
▪Parathyroid adenoma or hyperplasia
▪Pheochromocytoma.

MEN II B:
▪Medullary carcinoma of the thyroid
▪Mucousal neuromas
▪Pheochromocytoma
▪Marfanoid habitus.


#Endocrine

-The most common cause of esophageal perforation Is Iatrogenic .

-The first clinical sign of esophageal perforation is Pain .


#Esophagus

-Pharyngeal pouch aka Zenker's diverticulum , is a MUCOSAL outpouching through a weak area in the lower posterior pharyngeal wall known as Killian's dehiscence .

-It usually occurs in older population above the age of 60 , with 2:1 female predominance.

-Diagnosis is usually by imaging studies after clinical suspicion , with excellent results after barium swallow and the best being Videofluroscopic swallowing study .


#Esophagus

Remember:

-Smoking DOUBLES the risk of Crohn's disease , and HALVES the risk of Ulcerative colitis.

#Bowel

-Amiodarone is an Antiarrhythmic drug , however a major side effect of it is thyroid gland impairment .

#Thyroid

Most important features of congenital Cytomegalovirus infection :

1) It is the most common congenital infection acquired transplacentally.

2) It is a leading cause of microcephaly and mental retardation worldwide.

3) It is a leading cause of sensorineural hearing loss due to a congenital infection worldwide.

4) It can occur if the mother is chronically infected or have reactivated infection or if she was infected primarily with CMV, or if she gets infected with a new strain of CMV.

5) The commonest sources of maternal CMV infection is sexual contacts or contacts with young children.

6) The time of gestational age does not affect the risk of fetal transmission "e.g in Toxoplasmosis, the more advanced is the gestational age, the higher is the risk of fetal transmission, this is related to the amount of placental blood flow" ,, the risk of fetal transmission is near 35% if the mother acquire a primary CMV infection.

7) The severity of congenital CMV infection increases with decreasing gestational age.

#Infections

◼ BRCA-2 is a gene carried on the long arm of chromosome 13 that predispose its carriers to several types of cancers including Breast cancer.
◼ If cancer occurs in those patients, it's usually in a younger age, bilateral and of IDC type , other associated malignancies include ovarian, colon, prostate, gallbladder, pancreas, stomach, bladder cancers and melanoma.
◼ Special thing about BRCA-2 caused breast cancer is that it's usually hormone receptors positive ( BRCA-1 is usually HR negative ) and more well differentiated than that caused by BRCA-1 gene rendering it a Better prognosis.

#Breast

◼BRCA-1 gene is carried on the long arm of chromosome 17 and is associated with early onset of bilateral breast cancer ( IDC ) .
◼The gene is also associated with multiple other malignancies including ovarian, colon, and prostate cancers .

#Breast

Microdochectomy : it is the surgical removal (excision) of a lactiferous duct. A mere incision of a mammary duct (without excision) is called microdochotomy .

#Breast

Remember:

-Biopsy rather than any imaging modality is the Best DIAGNOSTIC method of any lump .

#Breast

-MRI is the Investigation of choice in High risk patients in breast cancer.

#Breast

-Long standing Lymphedema predispose to Lymphangiosarcoma ( Stewart Treves syndrome ) .


-This usually occurs 3-5 years after mastectomy and radiotherapy with multiple subcutaneous nodules.

-The condition had very bad prognosis.

#Breast

-Most common site for breast cancer is Upper outer quadrant.

#Breast

-Most common pathological type of breast cancer is Papillary carcinoma.

#Breast

#Most_common

Most common site for bony metastases in breast cancer is Lumbar vertebrae .

-Breast cancer is the most common cause of osteolytic bone metastases in adult female .

#Breast

Slit like nipple retraction :

Seen in mammary duct ectasia.

The scar above the nipple is due to incision made to drain an abcess caused by the periductal mastitis.

#Breast

Nipple retraction !

Nipple retention is not always due to malignancy as some benign conditions such as " mammary duct ectasia " can cause it as well , remember that it's important to exclude malignancy in any suspicious case .

◼Simple nipple inversion is retraction of the nipple which occurs at puberty and of unknown aetiology .
Inverted nipple could be problematic during lactation as it predispose to infections owing to retention of secretions.
Mechanical suction devices could be used to evert the nipples with suction of retained milk .


Recent retraction of the nipples could be of pathological significance.


◼Slit like retraction of the nipple may be due to mammary duct ectasia and chronic periductal mastitis .

◼Circumferential retraction with or without an underlying lump may well indicate and underlying Carcinoma!

#Breast