PG Blazer » Surgery

Ultrasound features of congenital diaphragmatic hernia

pgblazer — Mon, 21 May 2012 00:22:15 +0000

Ultrasound features of congenital diaphragmatic hernia are: Visualisation of abdominal organs in the chest Absence of normally positioned stomach Mediastinal displacement Small abdominal circumference Polyhydramnios Related Articles No related posts found

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Indications for sympathectomy

pgblazer — Mon, 07 May 2012 00:34:50 +0000

Indications for sympathectomy are:

Hyperhydrosis
Causalgia
Raynaud’s disease caused by stable arterial occlusions
Frost bite sequelae
Thromboangitis / distal arterial occlusions
Reflex sympathetic dystrophy
Inoperable atherosclerotic occlusions with pain or limited tissue loss

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Causes of acquired megacolon

pgblazer — Mon, 02 May 2011 15:11:11 +0000

Chagas disease – caused by Trypanosoma cruzi Anticholinergic drugs Rectal malignancy – causes luminal obstruction leading to development of megacolon Neurological diseases like multiple sclerosis and motor neuron disease Related Articles ...

Surgery MCQ 1

pgblazer — Tue, 18 Jan 2011 13:56:45 +0000

Commonest cause for pulsion diverticulum of the urinary bladder is? A. Benign enlargement of prostate B. Fibrous prostate C. Contracture of bladder neck D. Stricture urethra Correct answer : Contracture of bladder neck Related Articles ...

Factors responsible for malignant transformation in undescended testis

pgblazer — Tue, 18 Jan 2011 12:33:02 +0000

There is 40 times increased risk for malignant transformation in an undescended testis compared to testis located within the scrotum. The factors responsible for malignant transformation in undescended testis are: Elevated temperature Impairment of blood supply Abnormal germ cell morphology Endocrine dysfunction Gonadal dysfunction Related Articles ...

Varicocele is more common in left side – Mechanism

pgblazer — Tue, 18 Jan 2011 12:25:58 +0000

Varicocele is more commonly seen in the left side because of 3 reasons
- The left testicular vein opens at a right angle to the left renal vein
- The loaded sigmoid colon exerts pressure on the left testicular vein
- The opening of the left testicular vein is close to the opening of the adrenal veins – hence it is exposed to action of adrenergic hormones

Why is the gall bladder removed during Whipple procedure?

pgblazer — Tue, 18 Jan 2011 07:33:35 +0000

Whipple procedure consists of pancreaticoduodenectomy followed by pancreaticojejunostomy, choledochojejunostomy and gastrojejunostomy
Since the common bile duct is attached to the jejunum, the sphincteric action of sphincter of Oddi is no longer present
Bile continuously flows from the common bile duct to the jejunum
Hence the gall bladder can no longer perform its function of storage of bile
Since gall bladder function is lost, it acts as a focus of infection if retained after surgery
Hence the gall bladder is removed during Whipple procedure

Tumour in the solitary kidney – Management

pgblazer — Fri, 14 Jan 2011 01:18:01 +0000

Renal cell carcinoma can occur in a patient with a solitary kidney
The current recommendation is to do partial nephrectomy as long as sufficient margin of normal tissue is available
This helps to avoid the requirement of lifelong hemodialysis
Partial nephrectomy cannot be done in those with a large tumour or multiple small tumours throughout the kidney
Survival rates of upto 90% have been reported in stage I disease and upto 76% for stage III tumours with conservative surgery

Reference:
Diagnosis and Management of Cancer By Ashok Mehta, S.C. Bansal

Halstead’s Principles of Surgery

pgblazer — Fri, 31 Dec 2010 14:52:37 +0000

William S Halsted of John Hopkins University put forward a set of principles (Halstedian principles) in the 1890′s for achieving the best results in surgery. Now, more than 100 years later, they still form the basis of modern surgical craftsmanship.

Handle tissues gently
Achieve meticulous hemostasis
Preserve vascularity
Ensure strict asepsis
Close the wound without tension
Achieve good approximation of tissues
Avoid dead space

Mucous fistula – definition

pgblazer — Fri, 31 Dec 2010 13:28:18 +0000

Mucous fistula is a type of abdominal stoma. (Abdominal stoma is an artificial opening created in the abdominal wall as an alternate path for feces or urine to reach outside the body.)
When immediate anastomosis of bowel is not possible after resection, the proximal bowel is brought out as a stoma (eg: ileostomy, colostomy etc)
But in certain cases, the distal non functioning part of bowel is also brought out through a stoma
Such a stoma is known as a mucous fistula
It appears small, flat and pinkish red
It discharges only mucus – no fecal matter

Complications of chronic pancreatitis

pgblazer — Thu, 30 Dec 2010 12:45:26 +0000

Chronic pancreatitis can produce many complications which include:

Pseudocyst formation – cyst which does not have a endothelial lining
Obstructive jaundice – due to compression of common bile duct due to fibrosis
Portal hypertension – due to splenic vein thrombosis secondary to inflammation in tail of pancreas
Duodenal obstruction – secondary to fibrosis of head of pancreas
Colonic obstruction
Malnutrition – due to defective absorption of nutrients
Diabetes mellitus – due to dysfunction of beta cells of Islets of Langerhans

Common nonbacterial opportunistic organisms recovered from burn wounds

pgblazer — Wed, 29 Dec 2010 15:42:23 +0000

The most common non bacterial oppurtunistic organism recovered from burn wound is the fungus – Candida It has the potential to invade viable tissues, but it rarely does so Other fungi obtained from burn wounds include aspergillus and fusarium Related Articles ...

Seroma – Cause, Mechanism, Management and Prevention

pgblazer — Wed, 29 Dec 2010 15:26:47 +0000

Seroma is a collection of clear fluid in the wound that occurs after surgery or injury
They are different from hematomas (blood collection) and abscesses (pus collection)
Cause – Surgeries which involve damage to the cutaneous lymphatics especially breast and groin surgeries
Mechanism – Fluid that leaks from the lymphatics get accumulated under the skin
Clinical significance - Delays wound healing, increases risk of infection
Prevention – Placement of closed suction drain
Management – Aspiration, compression bandages

Free gas under the diaphragm – Xray

pgblazer — Thu, 24 Jun 2010 12:20:00 +0000

Free gas under the diaphragm - Xray

Click on image for an enlarged view

Free gas under diaphragm (also known as air under the diaphragm) is a finding in the chest Xray seen in case of perforation of hollow viscus.
When there is perforation, gas within the hollow viscus escapes into the peritoneal cavity along with other contents
When an chest xray is taken in the upright position, gas being lighter rises up and settles under the diaphragm and is seen in the xray as a radioluscent (dark) area
If the patient is supine when the xray is taken, the gas will settle at the region of the umbilicus and hence such a film is not useful in diagnosing hollow viscus perforation

Why is it called free gas?

It implies that the gas is localised within the peritoneal cavity and changes position with the posture of the individual
In other cases, as in case of gas within the retroperitoneum, the location of the gas is fixed and does not change with posture

When to suspect hollow viscus perforation:

Patients usually presents as a case of acute abdomen
The abdomen is tense and tender
Board like rigidity of the abdomen may be present

Differential diagnosis for free gas under diaphragm:

Most common cause is hollow viscus perforation. Site of perforation – ordered proximal to distal – with causes:
- Oesophagus -rupture (Boerhaave syndrome) – rare
- Stomach and duodenum
  - Peptic ulcer perforation – commonest
  - Malignancy eroding the wall
- Small bowel
  - Inflammatory bowel disease (eg: Chron’s disease)
  - Primary cancers of small bowel – extremely rare
  - Tumors encroaching upon bowel from adjacent structures (eg: mesenteric tumours)
- Large bowel
  - Diverticulitis (more seen in left side, especially sigmoid colon)
  - Malignancies
- Injury to vagnina or anus

Abdominal trauma as in stabs, gun shots, road traffic accidents
After laproscopic surgery

Management:

The diagnosis of free gas under the diaphragm necessitates emergency management.
Along with air, the gastric/intestinal contents also leak into the peritoneal cavity and the effects can be catastrophic.
Laparotomy has to be done immediately to localise site of leak.
Tissue should be taken for histopathology to rule out malignancy.
The perforation is to be repaired.
Peritoneal lavage can be done to remove as much of the spilled contents
There is high fatality rate for hollow viscus perforation as it may be due to a malignant process and associated complications like infections

Lumboperitoneal Shunt

pgblazer — Sun, 21 Mar 2010 00:30:48 +0000

Lumboperitoneal shunts are channels which facilitate drainage of CSF from the lumbar subarachnoid space to the peritoneal cavity
It can be used in conditions such as Pseudotumor cerebri and hydrocephalus for decreasing the intracranial pressure
The advantage of of lumboperitoneal shunt over ventriculoperitoneal shunt is that there is less incidence of intracranial complications
Some of the disadvantages are risk for scoliosis, sciatica and back pain
There is also the risk of the tube getting blocked and resultant increase in CSF pressure with worsening of clinical status

Cytoreduction surgery

pgblazer — Mon, 15 Mar 2010 15:53:08 +0000

Cytoreduction literally means reduction in the number of cells Cytoreduction surgery (also known as debulking surgery / cytoreductive surgery) aims at decreasing the tumor load by removing as much of the tumor as possible It is resorted to when complete surgical removal of the tumor is not possible Used along with chemotherapy / radiotherapy for achieving the best possible result eg: Debulking surgery for gynaecologic malignancy with extensive spread Related Articles ...

Tracheal shift to right due to thyroid swelling

admin2 — Tue, 03 Mar 2009 23:57:07 +0000

Tracheal shift to right due to thyroid swelling

Tracheal shift to right due to thyroid swelling seen above the level of the clavicle. Tracheal compression can rarely cause stridor in this situation.

Multiple air-fluid levels in intestinal obstruction

admin2 — Wed, 14 Jan 2009 14:28:59 +0000

Air fluid levels in intestinal obstruction

Plain X-ray abdomen showing multiple air fluid levels (yellow arrows) in a case of subacute intestinal obstruction.