Forwarded from Kenhub - Anatomy
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#Surgery Mesenteric Ischemia
Acute mesenteric ischaemia is the sudden decrease in blood supply to the bowel, resulting in bowel ischaemia and, if not promptly treated, rapid gangrene and death.
Acute mesenteric ischaemia is the sudden decrease in blood supply to the bowel, resulting in bowel ischaemia and, if not promptly treated, rapid gangrene and death.
Traditionally, mesenteric ischaemia presents with a generalised abdominal pain, out of proportion to the clinical findings, although it can often be more variable or subtle than this. The patient will typically complain of a diffuse and constant pain, with associated nausea and vomiting present in around 75% of cases.
On examination, the abdomen is often unremarkable* and the patient may find it difficult to localise the pain. However, remember late stage bowel ischaemia and necrosis can present as bowel perforation. Importantly, take note of any potential embolic sources, such as AF, heart murmurs, or signs of previous valvular replacement surgery.
On examination, the abdomen is often unremarkable* and the patient may find it difficult to localise the pain. However, remember late stage bowel ischaemia and necrosis can present as bowel perforation. Importantly, take note of any potential embolic sources, such as AF, heart murmurs, or signs of previous valvular replacement surgery.
An arterial blood gas (ABG) should be performed urgently, to assess the degree of acidosis and serum lactate, secondary to the severity of bowel infarction (however these may be falsely reassuring).
Routine blood tests that should be performed, including FBC, U&Es, clotting (especially if patient anti-coagulated), amylase*, and LFTs (if the coeliac trunk is affected, ischaemia of the liver may cause derangement), as well as a group and save.
Routine blood tests that should be performed, including FBC, U&Es, clotting (especially if patient anti-coagulated), amylase*, and LFTs (if the coeliac trunk is affected, ischaemia of the liver may cause derangement), as well as a group and save.
The definitive diagnosis of acute mesenteric ischaemia, for both arterial and venous mesenteric disease, requires a CT scan with IV contrast (as a triple phase scan, with thin slices taken in the arterial phase)
Arterial bowel ischaemia will initially show on CT imaging as oedematous bowel, secondary to the ischaemia and vasodilatation, before progressing to a loss of bowel wall enhancement* and then to pneumatosis.
Any suspicion of a bowel perforation warrants an initial erect CXR for evidence of perforation; if there is significant suspicion, then a CT abdomen with IV contrast is indicated
Arterial bowel ischaemia will initially show on CT imaging as oedematous bowel, secondary to the ischaemia and vasodilatation, before progressing to a loss of bowel wall enhancement* and then to pneumatosis.
Any suspicion of a bowel perforation warrants an initial erect CXR for evidence of perforation; if there is significant suspicion, then a CT abdomen with IV contrast is indicated
A subdural haematoma (SDH) is a collection of blood that forms in the subdural space, the space between the dura mater and the arachnoid mater (Fig. 1).
They can be classified as acute (< 3 days after injury), subacute (3-21 days), or chronic SDH (>21 days), or as simple (no associated parenchymal injury) versus complicated (associated underlying parenchymal injury)
Bleeding in a SDH occurs from tearing of the bridging veins that cross from the cortex to the dural venous sinuses, which are vulnerable to deceleration injury.
This subsequently leads to accumulation of blood between the dura and arachnoid and results in a gradual rise in intracranial pressure (ICP). This can lead to herniation and brainstem death if left untreated. #Surgery
They can be classified as acute (< 3 days after injury), subacute (3-21 days), or chronic SDH (>21 days), or as simple (no associated parenchymal injury) versus complicated (associated underlying parenchymal injury)
Bleeding in a SDH occurs from tearing of the bridging veins that cross from the cortex to the dural venous sinuses, which are vulnerable to deceleration injury.
This subsequently leads to accumulation of blood between the dura and arachnoid and results in a gradual rise in intracranial pressure (ICP). This can lead to herniation and brainstem death if left untreated. #Surgery
The placenta is a temporary organ that connects the developing fetus via the umbilical cord to the uterine wall to allow nutrient uptake, thermo-regulation, waste elimination, and gas exchange via the mother's blood supply; to fight against internal infection; and to produce hormones which support pregnancy. Placentas are a defining characteristic of placental mammals, but are also found in marsupials and some non-mammals with varying levels of development.
#anatomy
#anatomy
A splenectomy may also be recommended if you have cancer involving the spleen or certain diseases that affect blood cells. Certain conditions can cause the spleen to swell, making the organ more fragile and susceptible to rupture. In some cases, an illness, such as sickle cell disease, can cause the spleen to shrivel up and stop functioning. This is called an auto-splenectomy.
The most common disease-related reason for a spleen removal is a blood disorder called idiopathic thrombocytopenic purpura (ITP). This is an autoimmune condition in which antibodies target blood platelets. Platelets are needed to help blood to clot, so a person with ITP is at risk for bleeding. The spleen is involved in making these antibodies and removing the platelets from the blood. Removing the spleen can be done to help treat the condition.
#Surgery
The most common disease-related reason for a spleen removal is a blood disorder called idiopathic thrombocytopenic purpura (ITP). This is an autoimmune condition in which antibodies target blood platelets. Platelets are needed to help blood to clot, so a person with ITP is at risk for bleeding. The spleen is involved in making these antibodies and removing the platelets from the blood. Removing the spleen can be done to help treat the condition.
#Surgery
Epidural techniques frequently involve injection through a catheter placed into the epidural space. The injection can result in a loss of sensation (including the sensation of pain).
Spinal anaesthesia is a technique whereby a local anaesthetic drug is injected into the cerebrospinal fluid.
#anaesthesia
Spinal anaesthesia is a technique whereby a local anaesthetic drug is injected into the cerebrospinal fluid.
#anaesthesia
Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.
Compartment syndrome can be either acute or chronic.
Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.
Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.
#Surgery
Compartment syndrome can be either acute or chronic.
Acute compartment syndrome is a medical emergency. It is usually caused by a severe injury. Without treatment, it can lead to permanent muscle damage.
Chronic compartment syndrome, also known as exertional compartment syndrome, is usually not a medical emergency. It is most often caused by athletic exertion.
#Surgery
Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes. The swelling may occur in the face, tongue, larynx, abdomen, or arms and legs. Often it is associated with hives, which are swelling within the upper skin. #Medicine