SURGERY mci screening test and indian medical examz high yield important topics study tips
By Live Dr - Wed Feb 11, 3:15 am
Classification of wounds
|Clean||Viscus not opened|
|Clean contaminated||Viscus opened without spillage|
|Contaminated||Viscus opened with spillage|
|Dirty||Infected wounds, like abscesses|
|Primary haemorrhage||Immediately post-operative|
|Secondary haemorrhage||Within 7-14 days post-operative, due to infection.|
|Reactionary haemorrhage||Within 24 hours of surgery, due to slippage of ligature or hypertension.|
|Healing by primary intention||Clean, surgically closed wounds|
|Healing by secondary intention||Unsutured, infected wounds healing by granulation tissue formation.|
|Healing by tertiary intention||Delayed closure for infected surgical wounds, in which skin was kept open in initial operation.|
|Partial thickness graft||Thin graft / Thiersch graft – through the tips of papillae
Thick graft/ split skin grafts- all of epidermis and variable part of dermis.
|Whole thickness skin graft / Wolfe’s graft||Includes entire epidermis and dermis.|
|partial thickness graft||full thickness graft|
|Includes whole of dermis and part of epidermis.||Includes whole of epidermis and dermis.|
|Wound contraction is more||Wound contraction is minimal|
|Skin on the donor site can regenerate on its own.||Skin on the donor site cannot regenerate and hence needs to be closed.|
|Used for resurfacing large areas||Used for resurfacing small areas, as they match colour and texture.|
|Donor sites include upper thighs, buttocks, and abdominal walls.||Donor site includes post-auricular area and upper eyelids.|
*Skin graft can be stored in refrigerator for 2 weeks at 4 degrees centigrade
Happiness is having dreams, success is making those dreams come true.- C. A.Castro
ELEVENTH HOUR SURGERY 198
Skin grafts survive in recipient bed by
|Imbibtion||Absorption of nutrients into the graft which serves to feed the graft for the first 24 hours to 48 hours|
|Inosculation||Process whereby donor and recipient capillaries become aligned|
|Revascularization||Differentiation of connecting vessels into the arterioles and venules|
Homopolymer of glycolide
Homopolymer of polydioxanone
|Port-wine stain||Vascular malformation
Present at birth
|Strawberry angioma||Capillary haemangioma
Not present at birth
Appear at 1-3 weeks
|Salmon patch||Present at birth|
|Sinus||Blind track lined by granulomatous tissue, leading from the surface down to the tissues, which may contain cavity.|
|Fistula||Communicating track between two epithelial surfaces.
One connecting hollow viscus with surface is called external fistula.
One connecting two hollow viscera.
|TYPE OF edge||ULCER|
|Undermined edge||Tuberculous ulcer|
|Punched out edge||Gummatous ulcer
deep trophic ulcer
|Sloping edge||Healing traumatic ulcer|
|Raised beaded edge||Rodent ulcer|
|Rolled out edge||Squamous cell carcinoma|
Symbol of surgery is striped barber pole, derived from bloodletting practiced by barbers.
Pole was used for grasping to make veins prominent, red represents blood, and blue represents veins while white represents bandages. Ball on top is the basin to hold leeches and blood.
ELEVENTH HOUR SURGERY 199
ULCERS WITH EPONYMS
|Bazin’s ulcer||Small multiple ulcers in ankle region.
Associated with erythrocyanosis frigida; seen exclusively in young women.
Low grade ischemia of ankle, due to abnormally small or absent perforating arteries, arising from the posterior tibial or peroneal arteries.
|Footballer’s ulcer||Non healing ulcer over shin due to direct trauma by football.|
|Phagedenic ulcer||Tropical ulcers seen in malnourished, poorly immunized with history of trauma or insect bite. Infection is caused by Vincent’s organisms|
|Hunner’s ulcer||Interstitial cystitis
Bladder capacity is educed to 30-50 ml
CRANIAL HAEMATOMAS WITH THEIR CAUSES
|Epidural haematoma||Rupture of middle meningial artery|
|Subdural haematoma||Torn bridging veins (superior cerebral vein)|
|Subarachnoid haematoma||Aneurysm rupture|
|Intracerebral haemorrhage||Rupture of lenticulostriate arteries.|
Shape of hAematomaS on CT – scan.
|Acute Subdural haematoma||Concavo-convex|
|amputation level||stump length|
|Lisfranc’s||Disarticulation through tarso-metatarsal joint|
|Chopart’s||Disarticulation through midtarsal joint|
|Syme’s||Removal of foot anterior to medial malleolus|
What this power is I cannot say; all I know is that it exists and it becomes available only when a man is in that state of mind in which he knows exactly what he wants and is fully determined not to quit until he finds it.” Alexander Graham Bell
ELEVENTH HOUR SURGERy 200
|indication for operative treatment of penetrating thoracic injuries|
Large air leaks with inadequate ventilation or persistent collapse of lung
Drainage of more than 1500 ml of blood when chest tube is first inserted
Continuous hemorrhage of more than 200 ml per hour for > 3 consecutive hours
|Extrinsic system of coagulation||Factor 7|
|Common system of coagulation||Factors 1, 2, 5, 10|
|Intrinsic system of coagulation||Factors 8, 9, 11, 12.|
|PT||Detects deficiency of common and extrinsic system of coagulation.
Elevated in deficiency of factors 1, 2, 5, 7, 10.
Also elevated in liver disease and early vitamin K deficiency.
|PTT (aPTT / PPTk)||Detects deficiency of intrinsic and common system of coagulation.
Elevated in deficiency of factors 1, 2, 5, 8, 9, 10, 11, 12.
Also elevated in liver disease and late vitamin K deficiency, Von Willebrand’s disease, lupus anticoagulants.
|Clot solubility in urea||Detects factor 13.|
*Vitamin K dependant factors are 2, 7, 9, 10, proteins C and S.
Wallace’s rule of nine
To estimate the total body surface area in burns patient
|IN ADULTS||IN CHILDREN|
Each upper limb-9
Each upper limb-9
Each lower limb-13.5
*Hand -1 %
Most common nonbacterial opportunistic organism from burn wounds is candidiasis
Most common bacterial infection in burn wounds is pseudomonas
During the fifteenth century, sick people were often dressed in red and surrounded by red objects because it was though to help them get better.
eleventh hour surgery 201
|Cleft lip operation||Done at 3 – 6 months.|
|Cleft palate operation||Done between 6 months to 1.5 years.|
*Suture removal after cleft lip operation is done on fifth day.
|1||Pits on pressure, disappears on elevation / rest.|
|2||Non-pitting ; doesn’t disappear on elevation and rest|
|3||Irreversible skin changes like fibrosis and papillae.|
|Superior thyroid artery||Ligated close to superior pole to avoid external laryngeal nerve.|
|Inferior thyroid artery||Ligated away from pole to avoid recurrent laryngeal nerve.|
|Autograft||Received from self|
|Allograft||Received from same species|
|Isograft||Received from different individual who is genetically identical|
|Xenograft||Received from different species.|
|Signs / symptoms of ischemia|
|STORAGE OF BLOOD|
|Conditions indicating significant ischemia|
*Caludication is due to mild ischemia
Signs OF DVT
|Homan’s sign||Pain in the calf on dorsiflexion of the foot|
|Moses’ sign||Pain is caused by squeezing of the calf muscle form side to side|
Anyone can give up; it’s the easiest thing in the world to do. But to hold it together when everyone else would understand if you fell apart, that’s true strength.- Anonymous
Eleventh hour surgery 202
Occlusion in the region of bifurcation of aorta and internal iliac arteries, leading to
intermittent claudication involving both the buttocks, thighs and calves, with impotence in males.
*Most common vessel to be involved in embolism is femoral
Stages seen in Raynaud’s phenomenon
|Stage of local syncope / stage of blanching||Pallor|
|Stage of local asphyxia / stage of dusky anoxia||Cyanosis|
|Stage of recovery / stage of red engorgement||Redness|
Inflammatory reaction in the arterial wall, and neighbouring veins and nerves
More common in middle aged men
Associated with smoking
Segmental, small and medium sized arteries are affected
Both distal extremities are affected
|True aneurysm||Contains all the three layers of arterial wall|
|False aneurysm||Single layer of fibrous tissue as the wall of sac|
|Mycotic aneurysm||Produced by the growth of microorganisms in the wall of the vessel.|
|Cirsoid aneurysm||Mass of dilated pulsating serpiginous vessels, found in congenital arteriovenous aneurysms|
|Aneurismal varix||Artery and vein are communicating directly with a short wide channel|
|Varicose aneurysm||Anastomosis between artery and vein is indirect through an intermediate sac.|
*Atherosclerotic aneurysms are the commonest.
*Cimino fistula-for renal dialysis temporary iatrogenic av fistula is made in the wrist or ankle
If a finger is pressed on the artery proximal to a-v fistula, there will be slowing of pulse rate and rise in the diastolic pressure.
Squamous cell carcinoma which arises in a chronic benign ulcer or scar.
Most commonly seen in long standing venous ulcer.
If a surgeon in Ancient Egypt lost a patient while operating, his hands were cut off.
ELEVENTH HOUR SURGERY 203
|RODENT ULCER/ BASAL CELL CARCINOMA|
|90% of basal cell carcinomas are seen in the face.
Majority occur above the line connecting angle of mouth with lobule of the ear.
Commonest site is around the inner canthus of eye. (Tear cancer)
Typical rolled edge.
Spreads by local spread.
Geographical or ‘field fire’ basal cell carcinoma has irregular raised edge around the flat white scar.
Regional lymph node metastasis is characteristic
Superficial radiotherapy is the treatment of choice.
|Lymphatic spread is the commonest route of spread.
Best treated by surgery and local regional isolation and perfusion with high doses cytotoxic agents.
|Most common type||Superficial spreading|
|Least common type||Lentigo maligna melanoma|
|Least malignant||Lentigo maligna / Hutchinson’s freckle|
|Most malignant||Nodular variety|
|Most common site in males||Lower back|
|Most common site in females||Legs|
|Carcinoma breast is more common on||Left side|
|Most common site||Upper outer quadrant|
|Most common histological variant||Ductal carcinoma|
|Histological variant with good prognosis even in presence of axillary lymph node metastasis||Medullary carcinoma|
|Epulis||A swelling situated on the gum arising from the alveolar margin.|
|Dental cyst||Associated with chronically infected pulpless tooth.
Always associated with a normally erupted tooth.
|Dentigerous cyst||Associated with non erupted permanent tooth.
Cyst contains molar tooth
|Adamntinoma||True neoplasm of odontogenic epithelium.
Epithelia tumour arising from ameloblasts
Our greatest glory consists not, in never falling, but in rising every time we fall.
Eleventh hour surgery 204
First node in the ipsilateral axilla to drain the tumor in the breast.
Sentinel node biopsy is done in carcinoma breast and malignant melanoma
|Urine analysis is negative
Elevation will not decrease the pain (negative Phren’s sign)
In torsion of testis, the epididymis cannot be distinguished from the body of the testis, whereas in epididymitis, the body of the testis can be felt in the enlarged crescent of the epididymis.
Operation should not be delayed for more than 4 hours from the time of onset of symptoms
*Duplication of renal pelvis is the commonest congenital abnormality of the upper tract
*Commonest cause of lower urinary tract infection in boys is posterior urethral valve
Meatal ulcer with scabbing is the most common cause of acute retention in boys
|Cystic swelling containing clear lymph.
Its caused due to sequestration of apportion of a jugular sac from the lymphatic system , which fails to join and regular lymphatic system.
Commonest site is posterior triangle of neck.
Manifests in early infancy.
Excision is the treatment of choice.
|Cystic swelling developing from the remnant of Thyroglossal tract
Subhyoid position is the commonest
Moves with deglutition.
Excision is treatment.
Caused by the external opening of an infected Thyroglossal cyst
*Sternomastoid tumour/ Congenital torticollis
Caused by the infarction of the central portion of one of the sternomastoid muscle at the time of birth.
|In the UK there was 100 times more research money spent on AIDS than on Prostate cancer, but 100 times more men died from Prostate cancer than from AIDS.|
ELEVENTH HOUR SURGERY 205
|The thyroid moves with deglutition due to its attachment with the larynx and trachea by|
|Ligament of Berry
Posterior lamina of the pretracheal fascia
Levator glandulae thyroidae
*Commonest post operative complication in thyroidectomy is hemorrhage
|Truncal Vagotomy / vagectomy||Both the trunks of Vagus nerves are resected|
|Selective Vagotomy||Removal of all gastric fibres of the Vagus nerves, leaving the hepatic and celiac branches.|
|Highly selective Vagotomy-||Denervation of acid secreting part of stomach, keeping supply to the alkali secreting part of the stomach and other abdominal viscera intact.|
*Sterile pyuria is seen in tuberculosis
Golf hole ureteric orifice is seen in late stages of tuberculosis of urinary system as the ureter is pulled upward.
Seen in late stages of tuberculosis.
Fibrosis leads to reduced capacity
|Indications of percutaneous nephrolithotomy|
|Stones bigger than 3 cm
Anatomic abnormality like scoliosis or obesity
Stones unresponsive to eswl
Coexisting obstructive uropathy
|Contraindications TO Eswl|
Abdominal aortic aneurysm
Uncorrectable coagulation disorders
Stones in poorly draining hydronephrotic kidney.
Management of Ureteric stones
|Middle third||eswl / Ureteroscopic removal|
|Lower third||Ureteroscopic extraction|
Accept nothing, challenge everything.- Anonymous
Eleventh hour surgery 206
*Triple phosphate stones-
Consists of calcium-ammonium-magnesium phosphate
Usually formed as a result of inflammation.
Form Staghorn calculus.
|Locations of ectopic testis|
|Superficial inguinal pouch (commonest)
In front of the pubis
Superficial perineal pouch
Near the saphenous opening
|Undescended testis||Ectopic testis|
|The testis is arrested in its normal path of descent||Testis deviates from its normal path of descent|
|Usually undeveloped||Fully developed|
|Scrotum is not well developed||Scrotum is well developed|
|Spermatogenesis is poor||Spermatogenesis is perfect|
|May be associated with indirect inguinal hernia||Never associated with indirect inguinal hernia|
|Frey’s syndrome||Damage to the auriculotemporal nerve and greater auricular nerve.
On healing there is cross joining, so that when the patient eats, there is sweating in the parotid region.
|Crocodile tears||Following, facial nerve paralysis, due to inaccurate regrowth of regenerating fibers. S o on eating, there is lacrimation.|
|Beck’s triad of cardiac tamponade|
|muffled heart sounds|
|distended neck veins|
*Potts puffy tumour is seen in chronic frontal sinusitis, it is subperiosteal swelling with edema of scalp.
Painful and non suppurative swelling of 2nd and 3rd costal cartilage
Idiopathic gangrene of scrotum, mostly by hemolytic streptococci
Prussic acid, in a crystalline powder called Zyklon B, was used to kill in Germany’s gas chambers. The gas would paralyze the victim’s lungs, causing them to suffocate.
Eleventh hour surgery 207
Levator muscle spasm
Painful spasm of anal sphincter which awakens the patient at night
Infection of the distal pulp space, usually secondary to a puncture wound
Late osteomyelitis may develop
*Dercum’s disease / Adiposis dolorosa
Variant of lipoma in which there are tender lipomatosis on the trunk.
*Enlargement of Krause’s nodes (located at jugular foramen) leads to jugular foramen syndrome (compression of 9th, 10th, 11th cranial nerve)
*PSA over 4 ng /ml is abnormal
TURP syndrome is seen due to glycine absorption
*Thymoma is the most common mediastinal tumour
Most common malignant tumor of the mediastinum is Seminoma
*Superior vena cava syndrome is most commonly caused by lung cancer
A small part of vitello-intestinal duct remains patent near the umbilicus, giving to rise to a mucus discharging sinus, with its epithelium everted.
Acute pyelitis occurring in females soon after marriage.
*Seminoma is the most common testicular tumour
*Hypospadias commonest type Glandular
Fistula into urinary tract by diverticulosis gives rise to pneumaturia.
Intussusception is the most common cause of intestinal obstruction in children under 2 years of age
|Salivary gland||Histological type|
The more you sweat in training, the less you bleed in battle. – Anonymous
Eleventh hour surgery 208
|Commonest benign tumour of salivary glands
Patey’s operation/ superficial parotidectomy is done
Only involves parotid and usually lower portion.
Shows hot spot on Tc 99m pertechnate scan.
Superficial parotidectomy is done.
*Haemangioma is the most common benign tumours of parotid in children.
|indication of radiotherapy in parotid tumors|
Residual disease left at surgery
High grade lesion
Those who refuse surgery
Unfit for surgery
Unresectable local lesion
|Triad of Mikulicz’s disease|
|Enlargement of salivary glands
Narrow palpebral fissure
Parchment like dryness of mouth.
*Tongue carcinoma-Most common site
Anterior 2/3rd, near the lateral margin
|Most common complication of esophageal atresia
Seen ion elderly
Characteristic site is within inferior pharyngeal constrictor, between the oblique fibres and horizontal fibres, at Killian’s triangle
Lung abscess due to aspiration is the most common complication
*Plummer-Vinson syndrome/ Brown- Kelly -Paterson syndrome/ Sideropenic dysphagia
Esophageal web with iron deficiency anemia
Premalignant- precricoid carcinoma
*Palmar and solar keratosis is seen in esophageal cancer
In 1979 Dr. Christian Barnard was offered $250 000 by the American National Enquirer to perform a human head transplant.
Eleventh hour surgery 209
|Sclerosing agents for endoscopic sclerotherapy|
|Polidocanal / polydochyl
N-butyl-cyanoacrylate (glue injection)
Ethanolamine maleate/ oleate
Sodium tetradecyl sulphate
*Stomach is the conduit of choice after Oesophagectomy
Opportunistic Post Splenectomy Infection
|Blood disorders treatable by splenectomy|
Acquired hemolytic anemia
Thrombosis of Splenic veins leading to thrombophlebitic splenomegaly
Peritoneal hemorrhage irritates diaphragm causes referred pain to the left shoulder.
Rupture spleen shows non shifting dullness in the left flank
Anemia, leucopenia, and thrombocytopenia.
Compensatory bone marrow-hyperplasia
Improvement after splenectomy
Congestive splenomegaly with hypersplenism associated with cirrhosis and portal hypertension.
Winners never quit, and quitters never win.- Anonymous
Eleventh hour surgery 210
|Duct of Wirsung||Major pancreatic duct|
|Duct of Santorini||Minor pancreatic duct|
|Most commonly elevated and tested enzyme||Serum amylase|
|Low serum amylase is seen in||Serum protein loss in congestive heart failure|
|Single best enzyme for pancreatitis||Serum lipase|
|Pancreas is the only source of||Serum trypsinogen|
|Drugs inducing pancreatitis-||L-asparginase, thiazides, steroids.|
|Organism causing pancreatitis||Mumps.|
|Best prognosis||Gall stone pancreatitis|
*Serum amylase is not raised in acute appendicitis.
*Grey Turner’s sign
In hemorrhagic pancreatitis, bluish discoloration in the flank is seen.
Cullen’s sign- in hemorrhagic pancreatitis, bluish discoloration in the periumbilical area is seen.
*Most common site of pseudo pancreatic cyst is body and tail of pancreas
Pseudo cyst > 5 cm in diameter is an indication of drainage
Pseudocyst < 5 cm and < 6 weeks duration should be observed only
|Gastrinoma||Arises from G-cells
Produces Zollinger-Ellison syndrome
Arises from beta cells
|Glucagonoma||Arises from alpha cells.
Causes diabetes, anemia, thrombosis, skin rashes
|Somatostatinoma||Arises from delta cells.
Causes diabetes, gallstone, steatorhhoea, hypochlorhydria
Diarrhea with hypokalemia, hypochlorhydria.(pancreatic cholera)
Humans shed about 600,000 particles of skin every hour – about 1.5 pounds a year. By 70 years of age, an average person will have lost 105 pounds of skin.
Eleventh hour surgery 211
|Normal Portal pressure||6-12 cm of Hg.
10-15 mm of water
|Portal hypertension||> 40 mm of Hg.|
|Whipple’s criteria for diagnosis of hypoglycemia|
|Symptoms of hypoglycemia
Serum glucose < 2.8 mmoles/ L
Prompt relief of symptoms after glucose administration.
|Charcot’s triad is seen in cholangitis and bile duct stones|
|Portosystemic venous shuts|
|Anastomoses between veins of falciform ligament and superior and inferior epigastric veins- caput medusae
Anastomoses between gastric veins and esophageal veins-esophageal varices
Anastomoses between superior hemorrhoidal vein and middle and inferior rectal veins-hemorrhoids
Anastomoses between vein soft retroperitoneal structures and the body wall(veins of Retzius)
|Associated with presence of gas in the gallbladder
Seen in diabetics, due to infection with gas forming bacilli
Ultrasound shows gas in the gallbladder
Needs to be operated immediately.
|Structures in free border of lesser peritoneum
From anterior to posterior
|Common bile duct
The aim of education should be to teach us rather how to think, than what to think – rather to improve our minds, so as to enable us to think for ourselves, than to load the memory with thoughts of other men.-Bill Beattie
Eleventh hour surgery 212
|Boundaries||Cystic artery superiorly
Cystic duct inferiorly
Common hepatic duct medially
|Contents||Lymph node of Lund|
*Blood supply to the liver is derived 80% from portal vein and 20 % from hepatic artery.
*CAROLI’s disease-congenital dilatation of intrahepatic biliary tree.
*Caterpillar turn or Moynihan’s hump- tortuous right hepatic artery.
*Most common route of infection of liver is along the bile ducts followed by via the hepatic artery.
*Commonest cause of liver abscess is pyogenic 80 %
*Honey comb liver is found in actinomycosis
*In Budd Chiari syndrome, obstruction occurs at hepatic vein
*Haemangioma is the commonest benign tumour of the liver
*Commonest primary lesion causing metastasis to liver is colon carcinoma, pancreas, and breast
*Gold standard for liver imaging is triple phase spiral CT scan
*Upto 80 %of liver resection may be tolerated
*Acute cholecystitis- most commonly caused by E coli
|features||1 point||2 points||3 points|
|Encephalopathy||–||Grade 1/2||Grade 3, 4|
|Serum bilirubin||1-2 mg||2-3 mg||> 3mg|
|Serum albumin||> 3.5 mg||2.8 -3.5 mg||< 2.8 mg|
|Prothrombin time (seconds prolonged)||1-4||4-6||>6|
|Most common indication for hepatic transplantation||Chronic liver failure|
|In children||Biliary atresia is the most common indication|
Honey is believed to be the only food that does not spoil. Honey found in the tombs of Egyptian pharaohs has been tasted by archaeologists and found to still be edible.
Eleventh hour surgery 213
|METABOLIC DISEASES WHICH CAN BE CURED BY LIVER TRANSPLANTATION|
Alpha 1 antitrypsin deficiency
*Hogarth Pringle maneuver
Hepatic artery is compressed between fingers and thumb in lesser omentum through foramen, to stop bleeding from injured cystic artery, when it cannot be controlled by packing, suction and ligation f bleeding artery
|Hernia through foramen of Morgagni||Herniation through the retrosternal defect between sternal and costal attachment of diaphragm|
|Hernia through foramen of Bochdalek||Herniation posterolaterally through pleuro-parietal opening.|
|Spigelian||Interparietal and subumbilical herniation, lateral to rectus muscle at the level of arcuate line.|
|Richter’s hernia||Herniation of circumference of intestine|
|Littre’s hernia||Herniation of Meckel’s diverticulum|
|Maydl’s hernia||Hernia en W|
*Landmark for differentiating femoral hernia from inguinal hernia is the pubic tubercle
Neck of the sac of inguinal hernia is above and medial to it, while that of femoral hernia is below and lateral to it.
Landmark for differentiating direct from indirect inguinal hernia is inferior epigastric vessels.
Neck of direct is medial to it, while that of indirect is lateral to it.
|Herniotomy||Neck of the sac is transfixed and ligated and then the hernial sac is excised, no repair is done|
|Herniorrhapy||Herniotomy with repair of posterior all of the inguinal canal|
|Hernioplasty||Herniorrhapy with reinforced repair of the posterior wall of the inguinal canal by filing the gap between the conjoined tendon and inguinal ligament.|
*Congenital hypertrophic pyloric stenosis shows- hypochloremic alkalosis
Congenital pyloric stenosis is best diagnosed by usg-
Hypertrophied pyloric muscle mass > 4 mm or pyloric length > 14 mm
*Most common benign neoplasm of stomach is leiomyomas.
Those who don’t make decisions never make mistakes.
Eleventh hour surgery 214
|Posterior duodenal ulcer perforation||Intense hemorrhage due to rupture of gastroduodenal artery|
|Anterior duodenal artery perforation||Pneumoperitoneum and peritonitis|
|Typhoid ulcers are placed||longitudinally along the ileum|
|Perforation of typhoid ulcer usually occurs||in the 3rd week|
|Most common complication of typhoid||paralytic|
|Most common presentation||intestinal bleeding|
|Most common site involved||ileum|
*Tubercular ulcers are placed transversely along the ileum
*Acute mesenteric lymphadenitis is the disease with symptoms and signs most similar to those of acute appendicitis
*Carcinoid tumor is most frequently found in distal third of appendix
*Most common position of appendix-retrocecal
Acute nonspecific mesenteric adenitis of teenage girls.
*Treatment of duodenal atresia is duodenostomy
*Bishop Koop’s operation is done in meconium ileus
|Short bowel syndrome|
|Massive bowel resection
Minimum amount of small bowel required to prevent short bowel syndrome is 100 cm.
Absorption of fat, water, electrolytes, and vitamin b12 is affected.
Associated with hypergastrinemia
|Massive intestinal resection
Regional enteritis with multiple bowel reactions
A jejuno- ileal bypass for morbid obesity
|Meckel’s diverticulum||Result of partial obliteration of vitelline duct|
|Persistent vitelline fistula||Result of failure of closure of vitelline duct.|
*Meckel’s diverticulum is a true diverticulum, situated on antimesentric border
Present in 2 % population
2 inches long
2 feet proximal to ileo-colic valve.
Most common complication of Meckel’s diverticulum is intestinal obstruction followed by bleeding, and diverticulitis.
Kotex was first manufactured as bandages, during WWI.
Eleventh hour surgery 215
|Classic quartet of intestinal obstruction|
|early dumping syndrome||late dumping syndrome|
|Immediately after meals||Second hour after meals|
|Relief by lying down||Relief by eating|
|Aggravated by more food||Aggravated by exercise|
|Symptoms of epigastric fullness, sweating, light headedness, tachycardia, colic,||Symptoms of tremor , fainting, prostration|
|Blind loop syndrome|
|Stagnation of small intestinal contents by strictures, stenosis, blind-pouch syndrome, or diverticula, the bacterial flora in the stagnant area is increased in number
Leading to anemia, hypoproteinemia, steatorhhoea,
In distal small intestine, the abnormal bacterial flora compete for vitamin B12, leading to deficiency
In proximal small intestine, they deconjugate bile salts, leading to steatorhhoea.
Also leads to hypoproteinemia and avitaminosis.
*Red currant jelly stool is seen in intussusception
Peutz- Jegher’s syndrome
Familial adenomatous polyposis coli- 100% malignancy risk, autosomal dominant.
Gardner’s syndrome, Turcot’s syndrome.- 100% progression to malignancy
*Strawberry lesion of recto-sigmoid is due to infection by spirochete vincenti and bacillus fusiformis.
Grading of piles
|First degree||Contained within the anal canal|
|Second degree||Extruded on defecation, but return at the end of act|
|Third degree||Prolapse on defecation and then need to be manually reduced|
|Fourth degree||Prolapse on defecation and then cant be reduced|
I thought it was impossible too before I did it.- Lance Armstrong
Eleventh hour surgery 216
Treatment OF PILES
|2nd degree||Sclerosants , rubber banding|
|3rd degree||Sclerosants, rubber banding|
|4th degree||Rubber banding, haemorrhoidectomy.|
Anal fistulae with an external opening in relation to anterior half of anus tends to have a straight path, whereas those related to posterior half , usually have curving tracks and may be of the horseshoe variety.
*Most serious complication of end colostomies is parastomal hernia
|carcinoma colon left||carcinoma colon right|
|Obstructive syndromes predominate||Anemia is more common|
Duke’s classification of colon carcinoma
|Stage A||Growth is limited to the bowel|
|Stage B||Spread into adjoining structures, without lymphatic metastasis|
|Stage C||Lymphatic metastases|
Duke’s classification of rectal carcinoma
|Stage A||Growth limited to rectal wall|
|Stage B||Beyond rectal wall, but no involvement of lymph nodes|
|Stage C||Growth beyond rectal wall, with involvement of regional lymph nodes.|
*Bleeding is the earliest complication of rectal carcinoma followed by alteration of bowel movements
Viagra (sildenafil citrate) was initially studied for use in hypertension and angina pectoris. Phase I clinical trials suggested that the drug had little effect on angina, but that it could induce marked penile erections, thus leading to its use in impotence.
Eleventh hour surgery 217