1) The document discusses surgical procedures for treating benign gastric and duodenal diseases, including perforated duodenal ulcers, bleeding ulcers, and gastric outlet obstruction.
2) A common procedure is an omental patch, where the perforation is closed with sutures and overlaid with omentum. For bleeding ulcers, the ulcer bed may be oversewn and a vagotomy with pyloroplasty performed to reduce acid.
3) Gastric outlet obstruction can be treated with vagotomy and antrectomy or vagotomy with pyloroplasty or gastroenterostomy. The appropriate procedure depends on each patient's situation and medical history.
This document summarizes surgical procedures for treating mesenteric ischemia, focusing on techniques for chronic or acute intestinal ischemia. It describes preoperative evaluation including imaging, and planning considerations for chronic cases. Surgical options for chronic ischemia include visceral endarterectomy, transaortic endarterectomy, and mesenteric arterial bypass via antegrade or retrograde routes. Bypass grafts can be prosthetic or autologous vein. The document explains the techniques for these procedures.
Post ERCP tension pneumo-thorax a rare complication Ibrahim Masoodi
A 65-year-old female presented with right upper quadrant pain and vomiting for 5 days. Imaging showed CBD stones. During a difficult ERCP involving pre-cut sphincterotomy, the patient developed tension pneumothorax. Exploration found a duodenal tear that was repaired. Tension pneumothorax is a rare but serious complication of ERCP due to retroperitoneal or intraperitoneal air dissection through diaphragmatic pores. Immediate diagnosis and treatment is needed to prevent hemodynamic compromise.
Current role of surgery in the management of peptic ulce (1)Anil Haripriya
Surgery is now rarely used to treat peptic ulcer disease as medical treatment with H. pylori eradication and NSAIDs is usually effective. Surgery is indicated for refractory or recurrent cases, patients needing long-term steroids or NSAIDs, or emergencies like bleeding or perforated ulcers. Common surgeries include vagotomy with drainage or antrectomy, and laparoscopic approaches are now often used. Factors like previous treatments, complications, and patient health influence surgical choice. Complications can include recurrence, postgastrectomy syndromes, or early and long-term side effects.
Copy of Evaluation & Management of Postcholecystectomy syndrome in patients u...attaullah karimuddin
This thesis examines the evaluation and management of postcholecystectomy syndrome in patients who have undergone cholecystectomy surgery. The study aims to evaluate risk factors for developing postcholecystectomy syndrome in patients at Peoples Medical College Hospital. It will be a prospective observational study of 100 patients over one year. Data on patient demographics, symptoms, investigations and treatments will be collected and analyzed to identify risk factors and evaluate management strategies. The results will be compared to literature to improve understanding and management of postcholecystectomy syndrome.
1) Duodenal injuries are uncommon and difficult to diagnose and repair due to the duodenum's retroperitoneal location. The mortality rate for duodenal injuries is high.
2) Diagnosis of duodenal injuries requires a high index of suspicion as there is no single, fully accurate diagnostic test. CT scans, upper GI studies, and exploratory laparotomy can help diagnose duodenal injuries.
3) Treatment depends on the grade of the duodenal injury. Lower grade injuries may be treated with primary closure, tube duodenostomies, or jejunal patching. Higher grade injuries involving complete wall disruption may require duodenal resection or diversion procedures like duodenal divertic
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
The pancreas is protected posteriorly by the rib cage and muscles, and anteriorly by surrounding organs that absorb energy. It has relations superiorly, inferiorly, and posteriorly to major blood vessels. Injury can be blunt or penetrating, with indicators including pain, hematoma, and fluid abnormalities. Evaluation involves blood tests, imaging like CT or MRI, and possibly ERCP. Injuries are graded from I to V based on severity. Treatment ranges from observation to surgery like drainage, resection, or reconstruction of the pancreatic duct. Complications can include bleeding, leaks, and long term issues. A high index of suspicion is needed to identify pancreatic trauma.
The document discusses gastric cancer surgery, including classifications of resection margins (R0, R1, R2) and lymph node dissection (D1, D2, D3, D4). It describes procedures for different tumor locations like total gastrectomy for proximal or middle tumors versus subtotal gastrectomy for distal tumors. Complications after different reconstruction methods are outlined, and the use of palliative treatments for advanced cancer is covered.
This document summarizes surgical procedures for treating mesenteric ischemia, focusing on techniques for chronic or acute intestinal ischemia. It describes preoperative evaluation including imaging, and planning considerations for chronic cases. Surgical options for chronic ischemia include visceral endarterectomy, transaortic endarterectomy, and mesenteric arterial bypass via antegrade or retrograde routes. Bypass grafts can be prosthetic or autologous vein. The document explains the techniques for these procedures.
Post ERCP tension pneumo-thorax a rare complication Ibrahim Masoodi
A 65-year-old female presented with right upper quadrant pain and vomiting for 5 days. Imaging showed CBD stones. During a difficult ERCP involving pre-cut sphincterotomy, the patient developed tension pneumothorax. Exploration found a duodenal tear that was repaired. Tension pneumothorax is a rare but serious complication of ERCP due to retroperitoneal or intraperitoneal air dissection through diaphragmatic pores. Immediate diagnosis and treatment is needed to prevent hemodynamic compromise.
Current role of surgery in the management of peptic ulce (1)Anil Haripriya
Surgery is now rarely used to treat peptic ulcer disease as medical treatment with H. pylori eradication and NSAIDs is usually effective. Surgery is indicated for refractory or recurrent cases, patients needing long-term steroids or NSAIDs, or emergencies like bleeding or perforated ulcers. Common surgeries include vagotomy with drainage or antrectomy, and laparoscopic approaches are now often used. Factors like previous treatments, complications, and patient health influence surgical choice. Complications can include recurrence, postgastrectomy syndromes, or early and long-term side effects.
Copy of Evaluation & Management of Postcholecystectomy syndrome in patients u...attaullah karimuddin
This thesis examines the evaluation and management of postcholecystectomy syndrome in patients who have undergone cholecystectomy surgery. The study aims to evaluate risk factors for developing postcholecystectomy syndrome in patients at Peoples Medical College Hospital. It will be a prospective observational study of 100 patients over one year. Data on patient demographics, symptoms, investigations and treatments will be collected and analyzed to identify risk factors and evaluate management strategies. The results will be compared to literature to improve understanding and management of postcholecystectomy syndrome.
1) Duodenal injuries are uncommon and difficult to diagnose and repair due to the duodenum's retroperitoneal location. The mortality rate for duodenal injuries is high.
2) Diagnosis of duodenal injuries requires a high index of suspicion as there is no single, fully accurate diagnostic test. CT scans, upper GI studies, and exploratory laparotomy can help diagnose duodenal injuries.
3) Treatment depends on the grade of the duodenal injury. Lower grade injuries may be treated with primary closure, tube duodenostomies, or jejunal patching. Higher grade injuries involving complete wall disruption may require duodenal resection or diversion procedures like duodenal divertic
The document discusses pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, workup, staging, and treatment. Some key points:
- The pancreas is protected by surrounding structures but can be injured by penetrating trauma or direct blunt force.
- Injury is staged based on severity from grade I (minor) to grade V (massive disruption). Treatment depends on grade and location of injury.
- Workup may include labs, CT, MRCP, ERCP. Surgical treatment ranges from observation for minor injuries to distal pancreatectomy or pancreaticoduodenectomy for more severe injuries.
- Complications include pancreatic fistula, abscess, and pseudocyst.
The pancreas is protected posteriorly by the rib cage and muscles, and anteriorly by surrounding organs that absorb energy. It has relations superiorly, inferiorly, and posteriorly to major blood vessels. Injury can be blunt or penetrating, with indicators including pain, hematoma, and fluid abnormalities. Evaluation involves blood tests, imaging like CT or MRI, and possibly ERCP. Injuries are graded from I to V based on severity. Treatment ranges from observation to surgery like drainage, resection, or reconstruction of the pancreatic duct. Complications can include bleeding, leaks, and long term issues. A high index of suspicion is needed to identify pancreatic trauma.
The document discusses gastric cancer surgery, including classifications of resection margins (R0, R1, R2) and lymph node dissection (D1, D2, D3, D4). It describes procedures for different tumor locations like total gastrectomy for proximal or middle tumors versus subtotal gastrectomy for distal tumors. Complications after different reconstruction methods are outlined, and the use of palliative treatments for advanced cancer is covered.
This document provides an overview of pancreatic surgery and management of pancreatic conditions. It discusses the anatomy of the pancreas, classification and management of acute pancreatitis including necrotizing pancreatitis. It covers the indications, timing and approaches for intervention in infected pancreatic necrosis, including radiologic drainage, minimally invasive techniques like VARD and nephroscopic debridement, and open necrosectomy. It also summarizes the principles and techniques of surgical management of pancreatic cancer.
This document discusses esophageal resection and reconstruction techniques. It covers indications for resection such as carcinoma or injury. Common reconstruction conduits are the stomach, colon, jejunum or combinations. Reconstruction routes include posterior mediastinal, substernal or subcutaneous. Complications can include fistula, stricture or dysfunction. The goal is a viable patient with functional gastrointestinal continuity. Successful reconstruction lasts long, provides nutrition and is done safely with flexibility and a team approach.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
The document describes the Whipple procedure, which was first performed by Dr. Allen Whipple in 1935. It involves removing the head of the pancreas, part of the small intestine, the gallbladder, and bile duct. The original procedure was done in two stages but is now typically done in one stage. The document outlines the key steps of the modern Whipple procedure, including mobilizing tissues, dividing vessels, transecting organs, and reconstructing the digestive and biliary systems with anastomoses. Vascular resection of veins like the splenic vein may sometimes be required as well.
surgery, minimally invasive techniques, continuous closed ;lavage, necrosectomy, VARD, ideal time for intervention, role of antibiotics , laparoscpic surgery
Laparoscopy shows promise in the management of abdominal emergencies. For abdominal trauma, laparoscopy can accurately detect injuries while reducing unnecessary laparotomies compared to other diagnostic tests. It may avoid laparotomy in stable patients with penetrating injuries. For non-traumatic emergencies, laparoscopy can establish or rule out diagnoses like acute appendicitis or perforated ulcer while allowing therapeutic laparoscopy if needed, reducing negative laparotomies. Laparoscopy shows potential as a safe, accurate, and minimally invasive option for evaluating many abdominal emergency conditions.
Gastroesophageal reflux disease (GERD) is defined as the failure of the antireflux barrier, allowing abnormal reflux of gastric contents into the esophagus. It is a condition which develops when the reflux of stomach contents causes troublesome symptoms and complications.
Prevention and management of complications of pancreatic surgeryzeeshanrahman86
This document summarizes key complications of pancreatic surgery and strategies for prevention and management. The three most common complications are delayed gastric emptying (14%), wound infection (7%), and pancreatic fistula (5%). Mortality has decreased in high-volume centers to 5% while morbidity remains around 35-50%. Prevention focuses on risk stratification and measures like duct-to-mucosa suturing. Management involves NPO, TPN, antibiotics, imaging-guided drainage and re-exploration if needed.
This document summarizes key information about duodenal injuries:
- The duodenum is 12 inches long and located retroperitoneally behind the liver and pancreas. It has four parts and is vulnerable to trauma due to its location and proximity to other abdominal organs.
- Duodenal injuries can be from penetrating or blunt trauma. Diagnosis involves imaging like CT scans and upper GI series. Management principles involve restoring intestinal continuity, decompressing the duodenum, providing drainage, and nutritional support.
- Treatment options depend on the severity of injury and include primary repair, diversion procedures like gastrojejunostomy, or pancreaticoduodenectomy for severe injuries involving other structures. Complications can include
Pancreatic injuries can occur from both penetrating and blunt trauma. Penetrating injuries include stab or gunshot wounds while blunt injuries are often caused by direct blows to the abdomen from car accidents. Symptoms include epigastric pain, flank bruising, and progressive pain due to leakage of pancreatic fluids. Diagnosis involves blood tests showing elevated amylase levels and imaging studies like CT scans or MRCP to identify duct disruption. Treatment depends on the severity and location of the injury but may include surgery, drainage, or observation. Complications can include pancreatic fistulas, pseudocysts, or endocrine/exocrine insufficiency. The case report describes a 29-year old male who presented with abdominal pain after a car
This document provides information on gastric and duodenal ulcers. It discusses the anatomy and physiology of the stomach, factors involved in pathogenesis of peptic ulcers including H. pylori infection and NSAID use. Clinical manifestations, diagnosis, and treatment approaches including pharmacologic therapies targeting H. pylori and surgical procedures are described. Complications of ulcers and stomach surgeries like bleeding, perforation, obstruction and long term issues such as dumping syndrome and anemia are also summarized.
The document summarizes the surgical management of chronic pancreatitis. It describes various procedures including drainage procedures like Puestow and Partington & Rochelle procedures, and resective procedures such as duodenum-preserving pancreatic head resection (DPPHR), Frey procedure, and Whipple procedure. It compares these procedures in terms of indications, advantages, disadvantages, postoperative outcomes based on randomized controlled trials. The optimal treatment depends on the severity and location of disease.
The classic technique of PD consists of the en-bloc removal of the distal segment of the stomach (antrum), the first and the second portions of the duodenum, specifically the head of the pancreas, the distal CBD, and the gallbladder. Another approach to this procedure is known as the pylorus-sparing PD. In this approach, a small segment of the duo denum is left in situ with the entire stomach to preserve the pylorus and prevent the post–gastrectomy-related symptoms and complications. The classic Whipple and the pylorus-preserving operations are associated with comparable operation times, blood loss, hospital stays, mortality, morbidity, and the incidence of delayed gastric emptying (Mathur et al., 2015). The overall long-term and the disease-free survival is comparable in both groups.
This document summarizes information on gallbladder removal surgery (cholecystectomy). It discusses the history and types of cholecystectomy procedures, including open and laparoscopic techniques. Key points include that laparoscopic cholecystectomy has become the gold standard treatment for gallstone disease since the 1990s as it is associated with less pain, smaller incisions, shorter hospital stays and faster recovery compared to open cholecystectomy. However, laparoscopic approaches may be more technically challenging and carry a higher risk of bile duct injuries.
This patient underwent pancreaticoduodenectomy (PPPD) for pancreatic cancer and experienced a postoperative pancreatic fistula (POPF). On postoperative day 14, the abdominal drain output became blood tinged. Selective angiography revealed a pseudoaneurysm of the gastroduodenal artery (GDA), which was treated with successful embolization. Management of postoperative hemorrhage depends on whether it occurs early (<24 hours) or delayed (1-3 weeks) after surgery. Endoscopy or interventional radiology are options for stable patients, while reoperation may be necessary for unstable patients.
This document provides information on principles of gastrectomy, including:
- A brief history of gastrectomy procedures from the early 19th century to modern developments.
- Details on the anatomy, blood supply, lymph drainage of the stomach as relevant to gastrectomy.
- Descriptions of different types and techniques of gastrectomy for treating conditions like cancer, ulcers, and obesity.
- Information on pre-operative preparation, surgical techniques for different procedures like Billroth I and II reconstructions, and post-operative care and complications.
This document discusses various diseases of the colon, rectum, anus and provides treatment options. It covers:
1. Left sided colonic obstruction from colorectal cancer and options like stenting, colostomy, resection.
2. Colorectal liver metastases and various treatment sequences involving chemotherapy and surgery.
3. Left sided diverticulitis classified by Hinchey stages and treatments like resection or Hartmann's procedure.
4. Benign anorectal diseases including infections, hemorrhoids and rectal prolapse. Treatment may involve drainage, fistulotomy or abdominal procedures.
This document provides an overview of colorectal trauma and injuries. It discusses relevant anatomy, considerations for colonic and rectal trauma including classification systems, management approaches, and risks factors. It also reviews iatrogenic injuries that can occur from various surgical, endoscopic, and diagnostic procedures. Key points include that nondestructive colon injuries can often be primarily repaired, while destructive injuries require resection. Rectal injuries are classified using the "4Ds" concept of debridement, drainage, washout, and sometimes diversion.
Surgical treatment for peptic ulcer diseaseBashir BnYunus
This document discusses surgical treatments for peptic ulcer disease. It outlines relevant anatomy and physiology, classifications of PUD, indications for surgery, and various surgical options including vagotomy, gastrectomy, Graham's omental patch, and suture ligation of the gastroduodenal artery. Complications are also reviewed. The prognosis is generally satisfactory with operative procedures, though complications can include bleeding, leakage, obstruction, and recurrent ulceration. Delayed treatment increases morbidity and mortality risks.
1. The document summarizes guidelines for the management of bleeding duodenal ulcers, including the etiology, risk factors, clinical assessment, endoscopic diagnosis and treatment options.
2. Key recommendations include performing early endoscopy within 24 hours, using the Forrest classification system to assess bleeding risk, and employing combination endoscopic therapy with epinephrine injection and thermal coagulation or clipping for high risk stigmata.
3. Doppler ultrasound may help guide endoscopic therapy by identifying persistent blood flow signals requiring further treatment to reduce rebleeding risk.
This document provides an overview of pancreatic surgery and management of pancreatic conditions. It discusses the anatomy of the pancreas, classification and management of acute pancreatitis including necrotizing pancreatitis. It covers the indications, timing and approaches for intervention in infected pancreatic necrosis, including radiologic drainage, minimally invasive techniques like VARD and nephroscopic debridement, and open necrosectomy. It also summarizes the principles and techniques of surgical management of pancreatic cancer.
This document discusses esophageal resection and reconstruction techniques. It covers indications for resection such as carcinoma or injury. Common reconstruction conduits are the stomach, colon, jejunum or combinations. Reconstruction routes include posterior mediastinal, substernal or subcutaneous. Complications can include fistula, stricture or dysfunction. The goal is a viable patient with functional gastrointestinal continuity. Successful reconstruction lasts long, provides nutrition and is done safely with flexibility and a team approach.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
The document describes the Whipple procedure, which was first performed by Dr. Allen Whipple in 1935. It involves removing the head of the pancreas, part of the small intestine, the gallbladder, and bile duct. The original procedure was done in two stages but is now typically done in one stage. The document outlines the key steps of the modern Whipple procedure, including mobilizing tissues, dividing vessels, transecting organs, and reconstructing the digestive and biliary systems with anastomoses. Vascular resection of veins like the splenic vein may sometimes be required as well.
surgery, minimally invasive techniques, continuous closed ;lavage, necrosectomy, VARD, ideal time for intervention, role of antibiotics , laparoscpic surgery
Laparoscopy shows promise in the management of abdominal emergencies. For abdominal trauma, laparoscopy can accurately detect injuries while reducing unnecessary laparotomies compared to other diagnostic tests. It may avoid laparotomy in stable patients with penetrating injuries. For non-traumatic emergencies, laparoscopy can establish or rule out diagnoses like acute appendicitis or perforated ulcer while allowing therapeutic laparoscopy if needed, reducing negative laparotomies. Laparoscopy shows potential as a safe, accurate, and minimally invasive option for evaluating many abdominal emergency conditions.
Gastroesophageal reflux disease (GERD) is defined as the failure of the antireflux barrier, allowing abnormal reflux of gastric contents into the esophagus. It is a condition which develops when the reflux of stomach contents causes troublesome symptoms and complications.
Prevention and management of complications of pancreatic surgeryzeeshanrahman86
This document summarizes key complications of pancreatic surgery and strategies for prevention and management. The three most common complications are delayed gastric emptying (14%), wound infection (7%), and pancreatic fistula (5%). Mortality has decreased in high-volume centers to 5% while morbidity remains around 35-50%. Prevention focuses on risk stratification and measures like duct-to-mucosa suturing. Management involves NPO, TPN, antibiotics, imaging-guided drainage and re-exploration if needed.
This document summarizes key information about duodenal injuries:
- The duodenum is 12 inches long and located retroperitoneally behind the liver and pancreas. It has four parts and is vulnerable to trauma due to its location and proximity to other abdominal organs.
- Duodenal injuries can be from penetrating or blunt trauma. Diagnosis involves imaging like CT scans and upper GI series. Management principles involve restoring intestinal continuity, decompressing the duodenum, providing drainage, and nutritional support.
- Treatment options depend on the severity of injury and include primary repair, diversion procedures like gastrojejunostomy, or pancreaticoduodenectomy for severe injuries involving other structures. Complications can include
Pancreatic injuries can occur from both penetrating and blunt trauma. Penetrating injuries include stab or gunshot wounds while blunt injuries are often caused by direct blows to the abdomen from car accidents. Symptoms include epigastric pain, flank bruising, and progressive pain due to leakage of pancreatic fluids. Diagnosis involves blood tests showing elevated amylase levels and imaging studies like CT scans or MRCP to identify duct disruption. Treatment depends on the severity and location of the injury but may include surgery, drainage, or observation. Complications can include pancreatic fistulas, pseudocysts, or endocrine/exocrine insufficiency. The case report describes a 29-year old male who presented with abdominal pain after a car
This document provides information on gastric and duodenal ulcers. It discusses the anatomy and physiology of the stomach, factors involved in pathogenesis of peptic ulcers including H. pylori infection and NSAID use. Clinical manifestations, diagnosis, and treatment approaches including pharmacologic therapies targeting H. pylori and surgical procedures are described. Complications of ulcers and stomach surgeries like bleeding, perforation, obstruction and long term issues such as dumping syndrome and anemia are also summarized.
The document summarizes the surgical management of chronic pancreatitis. It describes various procedures including drainage procedures like Puestow and Partington & Rochelle procedures, and resective procedures such as duodenum-preserving pancreatic head resection (DPPHR), Frey procedure, and Whipple procedure. It compares these procedures in terms of indications, advantages, disadvantages, postoperative outcomes based on randomized controlled trials. The optimal treatment depends on the severity and location of disease.
The classic technique of PD consists of the en-bloc removal of the distal segment of the stomach (antrum), the first and the second portions of the duodenum, specifically the head of the pancreas, the distal CBD, and the gallbladder. Another approach to this procedure is known as the pylorus-sparing PD. In this approach, a small segment of the duo denum is left in situ with the entire stomach to preserve the pylorus and prevent the post–gastrectomy-related symptoms and complications. The classic Whipple and the pylorus-preserving operations are associated with comparable operation times, blood loss, hospital stays, mortality, morbidity, and the incidence of delayed gastric emptying (Mathur et al., 2015). The overall long-term and the disease-free survival is comparable in both groups.
This document summarizes information on gallbladder removal surgery (cholecystectomy). It discusses the history and types of cholecystectomy procedures, including open and laparoscopic techniques. Key points include that laparoscopic cholecystectomy has become the gold standard treatment for gallstone disease since the 1990s as it is associated with less pain, smaller incisions, shorter hospital stays and faster recovery compared to open cholecystectomy. However, laparoscopic approaches may be more technically challenging and carry a higher risk of bile duct injuries.
This patient underwent pancreaticoduodenectomy (PPPD) for pancreatic cancer and experienced a postoperative pancreatic fistula (POPF). On postoperative day 14, the abdominal drain output became blood tinged. Selective angiography revealed a pseudoaneurysm of the gastroduodenal artery (GDA), which was treated with successful embolization. Management of postoperative hemorrhage depends on whether it occurs early (<24 hours) or delayed (1-3 weeks) after surgery. Endoscopy or interventional radiology are options for stable patients, while reoperation may be necessary for unstable patients.
This document provides information on principles of gastrectomy, including:
- A brief history of gastrectomy procedures from the early 19th century to modern developments.
- Details on the anatomy, blood supply, lymph drainage of the stomach as relevant to gastrectomy.
- Descriptions of different types and techniques of gastrectomy for treating conditions like cancer, ulcers, and obesity.
- Information on pre-operative preparation, surgical techniques for different procedures like Billroth I and II reconstructions, and post-operative care and complications.
This document discusses various diseases of the colon, rectum, anus and provides treatment options. It covers:
1. Left sided colonic obstruction from colorectal cancer and options like stenting, colostomy, resection.
2. Colorectal liver metastases and various treatment sequences involving chemotherapy and surgery.
3. Left sided diverticulitis classified by Hinchey stages and treatments like resection or Hartmann's procedure.
4. Benign anorectal diseases including infections, hemorrhoids and rectal prolapse. Treatment may involve drainage, fistulotomy or abdominal procedures.
This document provides an overview of colorectal trauma and injuries. It discusses relevant anatomy, considerations for colonic and rectal trauma including classification systems, management approaches, and risks factors. It also reviews iatrogenic injuries that can occur from various surgical, endoscopic, and diagnostic procedures. Key points include that nondestructive colon injuries can often be primarily repaired, while destructive injuries require resection. Rectal injuries are classified using the "4Ds" concept of debridement, drainage, washout, and sometimes diversion.
Surgical treatment for peptic ulcer diseaseBashir BnYunus
This document discusses surgical treatments for peptic ulcer disease. It outlines relevant anatomy and physiology, classifications of PUD, indications for surgery, and various surgical options including vagotomy, gastrectomy, Graham's omental patch, and suture ligation of the gastroduodenal artery. Complications are also reviewed. The prognosis is generally satisfactory with operative procedures, though complications can include bleeding, leakage, obstruction, and recurrent ulceration. Delayed treatment increases morbidity and mortality risks.
1. The document summarizes guidelines for the management of bleeding duodenal ulcers, including the etiology, risk factors, clinical assessment, endoscopic diagnosis and treatment options.
2. Key recommendations include performing early endoscopy within 24 hours, using the Forrest classification system to assess bleeding risk, and employing combination endoscopic therapy with epinephrine injection and thermal coagulation or clipping for high risk stigmata.
3. Doppler ultrasound may help guide endoscopic therapy by identifying persistent blood flow signals requiring further treatment to reduce rebleeding risk.
This document provides information about open esophageal surgical procedures, including cricopharyngeal myotomy and excision of Zenker's diverticulum. It describes the preoperative evaluation and optimization of patients, including imaging, endoscopy, and nutritional support. The surgical technique is explained in 4 steps: 1) incision and dissection of the pharyngeal pouch, 2) myotomy of the cricopharyngeus muscle and esophagus, 3) freeing or excising the diverticulum using a stapler, and 4) drainage/closure. Postoperative care involves monitoring for complications such as recurrent laryngeal nerve injury, fistula, hematoma, and infection.
Open Versus Laparoscopic Surgery What is A Myth and What is Not!George S. Ferzli
The document summarizes several studies comparing laparoscopic and open surgery for various gastrointestinal procedures:
1) Minimally invasive esophagectomy is as safe as open surgery with a comparable complication rate and lymph node yield, and has advantages of less blood loss, shorter hospital stay and recovery time.
2) Laparoscopic esophagomyotomy and paraesophageal hernia repair have significantly less morbidity than open surgery but comparable symptomatic outcomes.
3) Laparoscopic Nissen fundoplication is as safe and effective as open surgery with similar functional results.
4) Laparoscopy-assisted Billroth I gastrectomy is safe and has advantages over open surgery including less surgical trauma and
This document summarizes the surgical management of complications from peptic ulcer disease. It discusses the trends in hospitalizations for ulcer disease over time, predictors of rebleeding, and the value of endoscopic treatments. For bleeding ulcers, the choice of operation depends on factors like the Forrest classification and ulcer location/type. For gastric outlet obstruction and perforation, the document compares non-operative and operative options and factors like vagotomy type, drainage procedures, and H. pylori status that influence choice of treatment.
Discuss the management of upper gastrointestinal haemorrhageBashir BnYunus
This document discusses the management of upper gastrointestinal haemorrhage. It outlines the principles of management which include immediate assessment, resuscitation, determining the bleeding site, treatment or intervention, and preventing recurrence. Non-operative treatments include endoscopic therapies for peptic ulcer disease and variceal bleeding. Surgical or angiographic intervention may be needed for uncontrolled or recurrent bleeding. Risk scoring such as the Rockall score can help predict prognosis and guide management decisions.
The document discusses the anatomy of the stomach, including its site, shape, parts, curvatures, and structure. It describes the stomach's relations to surrounding organs and tissues through ligaments like the lesser omentum, greater omentum, and gastrosplenic ligament. The document outlines the stomach's blood supply from the celiac trunk and its branches, including the left gastric, splenic, and hepatic arteries. It also notes the stomach's nerve supply and lymphatic drainage.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
Omentum – anatomy, pathological conditions and surgical importanceAravind Endamu
The omentum is a fold of tissue that hangs down from the stomach and extends over other abdominal organs. It has important functions like immunity, absorbing edema, and limiting spread of infection. The greater omentum develops from the dorsal mesogastrium and extends from the stomach to the transverse colon. The lesser omentum connects the stomach and duodenum to the liver. Pathologies of the omentum include cysts, torsion, and tumors. Clinically, the omentum helps drain collections, access the retroperitoneum surgically, and forms adhesions useful for patching perforations.
This document discusses intussusception, which is the telescoping of one segment of bowel into an adjacent segment. It provides definitions, etiology, types and pathology, signs and symptoms, differential diagnosis, workup, and treatment options for intussusception. The main points are that intussusception is usually idiopathic or caused by respiratory viruses in infants and young children, presenting with abdominal pain, vomiting, and bloody stools. Diagnosis involves imaging like ultrasound or barium enema. Treatment options include non-surgical reduction techniques like hydrostatic or pneumatic reduction or surgical reduction through manual manipulation or resection.
A 30-year-old female presented with acute left abdominal pain and nausea. Imaging showed an intussusception, which is when a segment of bowel invaginates into another segment, often causing obstruction. Intussusception is most common in children under 2 years old and is frequently idiopathic, while in adults it is often due to an underlying cause like tumors. Computed tomography is the most accurate way to diagnose intussusception based on its characteristic appearance.
Volvulus is a twisting of the intestine resulting in blood vessel compression and ischemia. There are three main types: midgut, cecal, and sigmoid volvulus. Risk factors include chronic constipation, abnormal intestinal contents, and congenital malrotation. Signs include abdominal distension, pain, vomiting, and rapid heart rate. Diagnostic tests include abdominal x-rays, blood work, barium enema, and CT scan. Treatment depends on the type but may include surgery, sigmoidoscopy, or monitoring for signs of ischemia. Complications can be dehydration, ischemic bowel disease, perforation, peritonitis, and sepsis.
This document discusses various radiographic signs that can indicate the presence of free air or pneumoperitoneum within the peritoneal cavity. It begins by explaining that pneumoperitoneum is most commonly caused by a perforation of the abdominal viscus, usually the stomach or bowel. It then presents 15 different named radiographic signs visible on abdominal x-rays that suggest pneumoperitoneum, such as the anterior subhepatic space free air sign and Rigler's sign. Each sign is accompanied by an illustrative image and brief explanation. Additional less common signs are also listed. References for further information are provided.
Intussusception is the invagination of one part of the intestine into another. It most commonly occurs in infants and children between 6 months and 2 years of age. Ultrasound is the preferred method of diagnosis as it can clearly visualize the "coiled-spring" or "bull's-eye" pattern of intussusception. Non-operative reduction using hydrostatic or pneumatic enema under fluoroscopic or ultrasound guidance is the first-line treatment and has high success rates of 80-95%. Surgical intervention is needed if non-operative reduction fails or if there is evidence of intestinal ischemia or perforation.
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
This document provides an overview of suturing techniques and knot tying. It discusses the history of suturing dating back to ancient Egypt, different suture materials and needles, wound healing processes, and various suturing techniques like simple interrupted, vertical mattress, and subcuticular stitches. It emphasizes the importance of mastering suturing skills like tying secure square knots using proper two-handed techniques to aid in wound healing and produce good cosmetic results.
Nanay Ganda, an 84-year-old female, was admitted to the hospital with complaints of inability to defecate for 4 days and intermittent abdominal pain over the past year. Imaging showed signs of partial intestinal obstruction. She underwent exploratory surgery where a tumor was discovered and removed at the descending colon. Biopsy results of the tumor were pending. Intestinal obstruction can be caused by adhesions, hernias, tumors and other issues. It requires prompt diagnosis and treatment, like surgery, to avoid increased mortality if left untreated.
1. Total body water content is approximately 60% of body weight in young adult males and 50% in young adult females. It is distributed between intracellular fluid (40% of total body water) and extracellular fluid (20% of total body water), with the extracellular fluid further divided between interstitial fluid and plasma.
2. Intravenous fluid therapy is indicated when oral intake is not possible or in conditions involving significant fluid and electrolyte imbalances. Common intravenous fluids include crystalloids like normal saline and Ringer's lactate, as well as colloids like albumin and hetastarch.
3. Selection of appropriate intravenous fluid depends on the clinical situation and includes factors like maintenance of hydration
This document provides an overview of intestinal obstruction, including its classification, common causes, clinical features, investigations, and treatment options. Intestinal obstruction can result from mechanical blockage from structural abnormalities (dynamic obstruction) or paralysis without physical obstruction (ileus). Common causes of dynamic obstruction include adhesions, hernias, volvulus, and intussusception. Clinical features include colicky pain, vomiting, abdominal distention, and constipation. Investigations may include blood tests, abdominal x-rays, and CT scans. Treatment involves resuscitation, nasogastric decompression, IV fluids, and potentially surgery to resolve the obstruction. Complications can include bleeding, infection, leakage, and reoccurrence of obstruction
Gas Under Diaphragm - Final Year MB BS LectureMr Adeel Abbas
This document discusses gas found under the diaphragm on chest x-rays. It notes that gas in this location is not always dangerous, as it can sometimes be present physiologically in the stomach or large intestine. However, if enteric contents are also leaking, this indicates a perforation which can be deadly. The document lists some potential causes of free air under the diaphragm and notes that upright chest x-rays are best for detecting it. Management principles include resuscitation, cleaning the peritoneal cavity, and repairing or diverting any perforation.
Acs0532 Procedures For Diverticular Disease 2004medbookonline
This document describes procedures for diverticular disease, including emergency and elective operations. The Hartmann procedure is described, which involves resection of the sigmoid colon and rectum with construction of an end colostomy. Alternatively, a primary anastomosis with diverting loop ileostomy can be performed. For emergency cases with perforation or obstruction, a temporary stoma such as a Hartmann is preferred to avoid the risk of anastomotic leakage. Elective/planned cases can undergo primary resection and anastomosis with diverting ileostomy. Laparoscopic techniques for resection are also discussed.
Gastric Perforation From Peptic Ulcer Disease - A Review of the Surgical Trea...Joseph A. Di Como MD
A PowerPoint presentation reviewing gastric perforation for peptic ulcer disease and a review of the surgical treatment options. Intended for medical professionals and students.
The document discusses complications of peptic ulcers, including perforation, hemorrhage, stenosis, and malignization. Perforation is the most common complication and can be difficult to diagnose, particularly in elderly patients or those on steroids. Treatment for perforated ulcers typically involves surgical closure of the perforation along with washing of the abdominal cavity and antibiotics. While laparoscopic repair is possible, open surgery is usually quicker and more effective at washing out stomach contents. Surgeons must also consider whether to add an ulcer-curing procedure like vagotomy or partial gastrectomy. Hemorrhage from peptic ulcers is also potentially lethal, with a mortality rate of 5-10%, and treatment involves resusc
The document discusses damage control surgery for abdominal trauma. It describes how multiple trauma patients often die from the metabolic triad of coagulopathy, acidosis, and hypothermia rather than surgical complications. Damage control surgery aims to control bleeding, prevent contamination, and protect organs in an abbreviated first operation, leaving the abdomen temporarily open. This is followed by intensive care to reverse metabolic failure and a planned second operation once the patient is stabilized.
ABDOMINAL INCISIONS AND LAPAROTOMY-1.pptxAbhijitAzeez
The theoretical advantage of a paramedian over a midline incision is
a diminished risk of wound dehiscence and incisional hernia
In practice, when these incisions are reopened, the medial edge of the rectus muscle is frequently adherent to the anterior or posterior sheath incision and does not effectively buttress the wound.
A “lateral paramedian incision” refers to a vertical incision created several centimeters lateral to the location of the traditional paramedian incision.
In the patient who has had prior abdominal surgery, the cosmetic advantages of reentering the abdomen through a preexisting scar must be balanced against the challenges associated with dissection in a reoperative field. Close proximity of a new incision to an old one should be avoided in order to minimize the risk of ischemic necrosis of intervening skin and fascial bridges.
Mass closure of the abdominal wall is usually advocated, using large bites and short steps in the closure technique and either non-absorbable (e.g. nylon or polypropylene) or very slowly absorbable suture material (e.g. polydioxanone suture (PDS)). It has been estimated that, for abdominal wall closure, the length of the suture material should be at least four times the length of the wound to be closed to minimise the risk of abdominal dehiscence or later incisional hernia.
1. Pancreatic cancer is the 4th leading cause of cancer death and often presents with jaundice, abdominal pain, weight loss, or new-onset diabetes. Diagnosis involves blood tests, CT, MRI, EUS, and biopsy.
2. Surgical management includes Whipple procedure for head tumors or distal pancreatectomy for body/tail tumors. Palliative options relieve biliary/duodenal obstruction and pain via stenting, bypass, or celiac plexus block.
3. Adjuvant chemo-radiotherapy after surgery can increase survival compared to surgery alone. Neoadjuvant FOLFIRINOX increases resectability of borderline resect
This document discusses several causes of gastric bleeding and disorders, including gastric tumors like gastrointestinal stromal tumors (GISTs) and gastric lymphoma. GISTs are sensitive to the drug imatinib and tumors over 5 cm in diameter have metastatic potential. Primary gastric lymphoma is usually treated with chemotherapy or surgery alone for early-stage disease, while widespread lymphoma involves chemotherapy.
This document provides an overview of gastric perforation. It begins with an introduction defining gastric perforation and noting the decrease in incidence due to treatment of H. pylori and acid hypersecretion. It then covers the anatomy of the stomach, etiologies of perforation including peptic ulcer disease, signs and symptoms, investigations like abdominal x-rays, and surgical management including repair techniques like omentoplasty and reconstructions like Billroth procedures. Post-operative complications are also discussed such as leakage, strictures, and syndromes. The role of vagotomy and drainage procedures is reviewed.
Pelvic gynecology intervention, complications and significance of teamwork co...Rustem Celami
Extensive gynecologic surgery often entails meticulous dissection near the bladder, rectum, ureters, and great vessels of the pelvis. Complications of gynecologic surgery include hemorrhage, infection, thromboembolism, and visceral damage. The risk of complications depends upon the extent and approach to surgery and patient characteristics. Understandably, the more common complications from this surgery relate to injuries to these viscera and occur during extensive resections for the treatment of cancer or when anatomy is distorted due to infection or endometriosis. Injuries to the gastrointestinal components are common during open gynecological surgery. Any delay in diagnosing a bowel perforation can lead to serious fecal peritonitis and even death. If a patient is experiencing pain, tachycardia, and fever following surgery, bowel injury should be suspected, warranting immediate consultation with a general surgeon. Gynecologists routinely operate on patients with risk factors for bowel injury; obesity, endometriosis, multiple abdominal procedures, pelvic inflammatory disease, history of malignancy, and advanced age. A general surgeon is often called, however, for bowel repairs that can be performed by a gynecologist with sufficient training and experience. There are instances, however, in which a general surgical consultation may not be readily available, another reason to master repair of bowel injuries encountered during gynecologic surgery. In conclusion, sufficient training of principles of intestinal surgery, and close collaboration with general surgeons is very important for management of these complications and a successful outcome.
Interventional radiology has evolved from providing purely diagnostic information to offering minimally invasive therapeutic alternatives to treat abdominal, thoracic, and vascular disorders. Procedures such as biopsies, drainages, angioplasty and stenting can now replace conventional surgery in many cases. Common interventional radiology procedures include liver biopsies, ERCP, PTC, percutaneous nephrostomies, gastrostomies, angioplasty and stenting of vessels. These procedures help diagnose and treat conditions affecting many organ systems such as the liver, bile ducts, kidneys, blood vessels and gastrointestinal tract.
The document discusses guidelines for the prevention and treatment of parastomal hernias. It finds that the incidence of parastomal hernias is 30-50% depending on follow up time, with terminal colostomies having a higher risk than lateral colostomies or ileostomies. Risk factors include age, obesity, infection and surgical technique. Mesh repair during hernia surgery results in lower recurrence rates of 7-17% compared to 69.4% for primary suture repair. Laparoscopic and open intraperitoneal mesh techniques have recurrence rates of around 10%. Prophylactic mesh placement during stoma creation may decrease hernia rates.
Endoscopic drainge of pancreatic absces inchildrenMEDHAT EL-SAYED
This case study describes the minimally invasive management of necrotizing pancreatitis in a 13-year-old pediatric patient. The patient presented with severe abdominal pain, respiratory distress, shock, and other symptoms. Imaging showed necrosis of the pancreatic body and tail with fluid collections. The patient was admitted to the ICU and received antibiotics, fluids, and other supportive care. An endoscopic transmural drainage was performed to drain the fluid collections. The patient's condition improved and follow-up imaging showed resolution of the fluid collections over time with endoscopic management. The case demonstrates the successful treatment of necrotizing pancreatitis in a pediatric patient with minimally invasive endoscopic drainage.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
Acs0522 Procedures For Benign And Malignant Biliary Tract Disease 2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It describes common operations to treat biliary tract diseases, emphasizing details of operative planning and technique. Key points include:
- Thorough preoperative imaging is important to define anatomy accurately.
- Biliary obstruction can cause secondary issues like infection, renal dysfunction, impaired immunity, and malnutrition, so these should be addressed preoperatively if possible.
- Exposure of the hepatoduodenal ligament and porta hepatis is critical during open procedures. Adhesions may require specific dissection techniques.
- Biliary anastomoses generally heal well if blood supply is preserved, tension is avoided, and sutures are placed
Acs0533 The Surgical Management Of Ulcerative Colitis 2004medbookonline
This document discusses procedures for ulcerative colitis. It outlines indications for both emergency and elective surgery to treat ulcerative colitis. Emergency operations are needed for fulminant colitis, toxic megacolon, massive hemorrhage, or perforation. Elective operations are considered for chronic symptoms, steroid dependency or refractoriness, dysplasia or cancer risk, or strictures. The goal of emergency surgery is to remove diseased colon to improve the patient's condition, while elective operations can cure intestinal manifestations through removal of the entire large intestine.
Incidental appendectomy is the removal of the appendix during another operation when there is no evidence of appendicitis. It may be performed during operations for malrotation to prevent future diagnostic confusion, as well as during hernia repairs and gynecologic or trauma surgeries. While it prevents future appendicitis, it increases operative time and risk of contamination. The appendix can also be useful for urologic reconstruction like ureteral repairs or the Mitrofanoff procedure to create a continent urinary stoma. It is also used in some cases of biliary reconstruction or for a Malone antegrade continence enema procedure to allow bowel evacuation through an abdominal stoma. The decision to remove the appendix
This document discusses surgical implications of jaundice. It covers causes and approaches to patients with obstructive jaundice. Investigations like ultrasound, CT, ERCP and MRCP are used for diagnosis. Conditions discussed include gallstone disease, cholangiocarcinoma, pancreatic cancer and choledochal cyst. Surgical treatments depend on the specific condition and may include ERCP, CBD exploration, Whipple procedure or liver transplantation. Splenectomy is used to treat jaundice in hereditary hemolytic anemias. Portal hypertension is managed with procedures like TIPSS or band ligation of varices.
Similar to Acs0520 Procedures For Benign And Malignant Gastric And Duodenal Disease 2006 (20)
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document provides reference values for many common clinical chemistry analytes measured in various specimens like plasma, serum, urine, and whole blood. The analytes include metabolic panels, lipids, proteins, electrolytes, vitamins, and more. Reference ranges are given in conventional and SI units for each analyte. The purpose is to provide clinicians with the normal expected ranges to interpret laboratory results at the Massachusetts General Hospital.
Acs0905 Gynecologic Considerations For The General Surgeonmedbookonline
This document discusses several gynecologic conditions and considerations for general surgeons:
- Gynecologic emergencies like bleeding from ovarian cysts, adnexal torsion, pelvic inflammatory disease, and ectopic pregnancy. Diagnosis and treatment approaches are outlined.
- Outpatient gynecologic problems including evaluating pelvic masses and abnormal uterine bleeding.
- Gynecologic malignancies like ovarian and cervical cancer that some general surgeons may encounter.
- Most conditions can be initially managed conservatively but may require surgery depending on patient stability or response to treatment. Diagnostic tools like ultrasound, CT, and laparoscopy are discussed.