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.
The document discusses varicocele, a dilation of the veins within the scrotum that can affect male fertility. It notes that varicoceles occur in 15% of the male population and 35% of male infertility cases. The document recommends surgical treatment of varicoceles to improve semen parameters, sperm DNA integrity, and the likelihood of spontaneous and assisted pregnancy. It presents evidence that varicocele repair prior to IVF/ICSI procedures increases fertilization rates, live birth rates, and successful sperm retrieval compared to proceeding with IVF/ICSI without prior repair. The key takeaway is that surgical treatment of varicoceles has a positive impact on fertility outcomes.
The document discusses adnexal masses discovered during Cesarean section. It notes that the incidence of discovering adnexal masses during C-sections has increased to around 0.49-1.64% as C-section rates have risen. Around half of masses are diagnosed incidentally during C-section. Common types of masses include follicular cysts, endometriomas, dermoids and paraovarian cysts. Management depends on size and appearance - smaller cystic masses may be observed while larger or suspicious masses should be removed to prevent complications. Removal during C-section can be done safely without increased risks when needed.
This document describes a case report of a young female patient who developed a rare complication of port site tuberculosis after undergoing a laparoscopic cholecystectomy procedure outside the reporting hospital. She presented with a non-healing discharging sinus at the epigastric port site that recurred after multiple debridement attempts. Further investigation and excision of the sinus tract revealed features consistent with tuberculosis on histopathology. The patient was started on anti-tubercular therapy and had no recurrence after 3 months of follow-up. Port site tuberculosis is an uncommon but important complication after laparoscopic surgeries that can result from improper sterilization of instruments or endogenous seeding from an undiagnosed primary tuberculosis infection
This document discusses guidelines and considerations for angiography in patients presenting with subarachnoid hemorrhage (SAH). It notes that angiography should be performed promptly to establish the diagnosis and facilitate timely treatment. It also discusses risks and complications of the procedure, as well as technical aspects such as ensuring adequate patient monitoring and use of specialized projections. The document provides guidance on distinguishing aneurysms, following up on negative studies, and using angiography to assess for cerebral vasospasm.
This document discusses obstetric anal sphincter injuries (OASIS), including its prevalence, risk factors, prevention strategies, and consequences of missed diagnoses. OASIS occurs in 0.5-2.5% of vaginal deliveries and can lead to fecal incontinence and long-term pelvic floor issues. Risk factors include midline episiotomy, prolonged second stage of labor, forceps delivery, and nulliparity. Prevention strategies focus on modifiable factors like restrictive episiotomy, perineal protection, warm compresses, and positions during delivery. Proper diagnosis and repair are also important to reduce short and long-term morbidity. Training and documentation are crucial to prevent missed
This document provides guidelines for screening, diagnosing, staging, and treating localized and locally advanced prostate cancer. It recommends offering PSA screening to higher risk men and using MRI to help guide biopsies. For diagnosis and staging, it recommends prostate biopsies, imaging like MRI and bone scans, and evaluating life expectancy. For treatment of localized disease, it discusses active surveillance, surgery, radiation therapy, cryotherapy, HIFU and hormonal therapy. It provides guidance on treating low, intermediate and high risk localized disease as well as locally advanced disease. It also addresses adjuvant therapy, biochemical recurrence, and second line therapies.
The document discusses varicocele, a dilation of the veins within the scrotum that can affect male fertility. It notes that varicoceles occur in 15% of the male population and 35% of male infertility cases. The document recommends surgical treatment of varicoceles to improve semen parameters, sperm DNA integrity, and the likelihood of spontaneous and assisted pregnancy. It presents evidence that varicocele repair prior to IVF/ICSI procedures increases fertilization rates, live birth rates, and successful sperm retrieval compared to proceeding with IVF/ICSI without prior repair. The key takeaway is that surgical treatment of varicoceles has a positive impact on fertility outcomes.
The document discusses adnexal masses discovered during Cesarean section. It notes that the incidence of discovering adnexal masses during C-sections has increased to around 0.49-1.64% as C-section rates have risen. Around half of masses are diagnosed incidentally during C-section. Common types of masses include follicular cysts, endometriomas, dermoids and paraovarian cysts. Management depends on size and appearance - smaller cystic masses may be observed while larger or suspicious masses should be removed to prevent complications. Removal during C-section can be done safely without increased risks when needed.
This document describes a case report of a young female patient who developed a rare complication of port site tuberculosis after undergoing a laparoscopic cholecystectomy procedure outside the reporting hospital. She presented with a non-healing discharging sinus at the epigastric port site that recurred after multiple debridement attempts. Further investigation and excision of the sinus tract revealed features consistent with tuberculosis on histopathology. The patient was started on anti-tubercular therapy and had no recurrence after 3 months of follow-up. Port site tuberculosis is an uncommon but important complication after laparoscopic surgeries that can result from improper sterilization of instruments or endogenous seeding from an undiagnosed primary tuberculosis infection
This document discusses guidelines and considerations for angiography in patients presenting with subarachnoid hemorrhage (SAH). It notes that angiography should be performed promptly to establish the diagnosis and facilitate timely treatment. It also discusses risks and complications of the procedure, as well as technical aspects such as ensuring adequate patient monitoring and use of specialized projections. The document provides guidance on distinguishing aneurysms, following up on negative studies, and using angiography to assess for cerebral vasospasm.
This document discusses obstetric anal sphincter injuries (OASIS), including its prevalence, risk factors, prevention strategies, and consequences of missed diagnoses. OASIS occurs in 0.5-2.5% of vaginal deliveries and can lead to fecal incontinence and long-term pelvic floor issues. Risk factors include midline episiotomy, prolonged second stage of labor, forceps delivery, and nulliparity. Prevention strategies focus on modifiable factors like restrictive episiotomy, perineal protection, warm compresses, and positions during delivery. Proper diagnosis and repair are also important to reduce short and long-term morbidity. Training and documentation are crucial to prevent missed
This document provides guidelines for screening, diagnosing, staging, and treating localized and locally advanced prostate cancer. It recommends offering PSA screening to higher risk men and using MRI to help guide biopsies. For diagnosis and staging, it recommends prostate biopsies, imaging like MRI and bone scans, and evaluating life expectancy. For treatment of localized disease, it discusses active surveillance, surgery, radiation therapy, cryotherapy, HIFU and hormonal therapy. It provides guidance on treating low, intermediate and high risk localized disease as well as locally advanced disease. It also addresses adjuvant therapy, biochemical recurrence, and second line therapies.
This study assessed the efficacy of bilateral uterine artery chemoembolization with methotrexate for treating cesarean scar pregnancies (CSPs). Forty-six women with CSPs underwent this procedure. It was found to be a safe and effective treatment, with 45 of 46 patients successfully treated. Complications were mainly fever and pain, which were alleviated with treatment. All patients recovered normal menstruation after treatment. This procedure caused less morbidity than current CSP treatment approaches.
This document provides an overview of pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, diagnosis, and management. Some key points:
- The pancreas is protected by surrounding structures but can still be injured, especially through penetrating trauma or direct blunt force from seatbelts.
- Pancreatic injuries are often classified based on their cause and location. CT scans and ERCP can help diagnose and determine the severity of ductal injuries.
- Most patients with pancreatic trauma have additional internal injuries. Mortality rates are around 20%.
- Mild injuries can be managed conservatively but more severe injuries involving ducts or the pancreatic head may require surgery like distal pancreatectomy or exploration
EVIDENCE BASED PRACTICAL TIPS FOR OFFICE HYSTEROSCOPY BY DR SHASHWAT JANI DR SHASHWAT JANI
This document provides evidence-based practical tips for office hysteroscopy. It discusses appropriate patient selection, instrumentation, techniques such as the vaginoscopic approach, use of distension media, and tips for managing complications. Key recommendations include using the smallest possible hysteroscope, considering NSAIDs for analgesia, and addressing any contraindications to minimize risks. Office hysteroscopy is presented as a generally safe procedure that can provide diagnostic and some operative capabilities when performed properly.
This document discusses complications that can occur during and after hysteroscopy procedures. It begins by stating that the overall complication rate is around 2% according to studies. It then discusses specific direct complications like cervical injury, uterine perforation, hemorrhage, infection, and thermal damage. Indirect complications include reactions to anesthesia or distention media. The document provides details on managing three main complications - uterine perforation, hemorrhage, and injury to other organs like the bowel or bladder. It emphasizes the importance of proper training, experience, instruments and use of distention media like CO2 to reduce complications.
This document provides information about hysteroscopy, including:
- A hysteroscope is an endoscope used to visualize the uterine cavity and perform procedures.
- It describes the historical development of hysteroscopy from the 19th century to modern techniques.
- The types of hysteroscopes and instrumentation used are outlined, including distention media, electrodes, sheaths, and cameras.
- The document discusses the procedures, indications, contraindications and complications of diagnostic and operative hysteroscopy.
The document discusses the history and management of penetrating abdominal wounds. It notes that in the 19th century such wounds were managed non-operatively with high morbidity and mortality rates, but that experience from wars led to more aggressive operative management. In 1960, Shaftan developed a selective approach of conservatism for stab wounds. The document focuses on abdominal stab wound exploration as a technique for determining if laparotomy is needed in asymptomatic patients, noting its safety, speed and cost-effectiveness. It provides details on patient selection, contraindications, anesthesia, equipment, positioning and technique for abdominal stab wound exploration.
In this presentation nuclear medicine application in nephrology is explained in detail based on UPTODATE evidence based recommendations.
Different examples were given.
In this PPT I am discussing about post-operative fever on POD#3. This is commonly due to catheter associated urinary tract infection- CA-UTI. The cause is keeping urinary catheter too long. I am discussing about how to diagnose this problem and how to manage it. you can watch all my teaching videocasts in the following links:
surgicaleducator.blogspot.com
This document provides guidelines for nursing management of patients with nephrostomy tubes. Nephrostomy tubes are inserted through the skin into the kidney to provide drainage for various conditions. Tube types include pigtail and wide bore catheters. Care involves irrigation, securing tubes, monitoring output, and educating patients prior to discharge. Nurses must follow sterile technique, check tubes regularly for patency and complications, and maintain fluid balances. Medical orders are required for irrigation and tube removal.
This document outlines a study protocol to evaluate a novel transvaginal surgical approach for repairing caesarean section scar defects. The study will recruit 60 symptomatic women to undergo transvaginal repair involving endometrial curettage of the scar defect cavity and suturing of the defect. Patients will be followed for 6 months with clinical and ultrasound evaluations at regular intervals to assess outcomes. The goal is to evaluate if this approach can effectively repair scar defects while avoiding complete excision of healthy myometrium.
(Albayrak, 2011) post partum haemorrhage from the lower uterine segment secon...dadupipa
This document describes the successful use of intrauterine Foley balloon tamponade for managing postpartum haemorrhage from the lower uterine segment secondary to placenta praevia or accreta during caesarean delivery. Fifteen women experiencing heavy bleeding unresponsive to other conservative measures had a Foley catheter inserted into the uterus with its balloon inflated. This achieved haemostasis in all cases. The balloon was left in place for 18-24 hours then gradually removed. This technique provides an effective conservative option before more invasive interventions for controlling lower uterine segment bleeding during caesarean delivery complicated by placenta praevia or accreta.
This document discusses first trimester bleeding, which occurs in 20-40% of pregnancies. The main causes are miscarriage (95%), ectopic pregnancy (2%), hydatidiform mole (<1%), and vanishing twin. Diagnosis involves history, examination, ultrasound to determine if the pregnancy is intrauterine, extrauterine, viable, or nonviable. Common ultrasound findings for miscarriage include no fetal heartbeat, subchorionic bleeding, or an empty gestational sac over 20mm. Ectopic pregnancies may appear as an adnexal mass. Rare causes are molar pregnancies, appearing on ultrasound as a "snowstorm" pattern of cysts in the placenta. First trimester bleeding
Sonohysterography (SIS) involves inserting a catheter into the uterus and using saline solution to distend the uterine cavity during an ultrasound exam. It allows visualization of the endometrial cavity and identification of polyps, submucous fibroids, and other causes of abnormal uterine bleeding. Studies show SIS has high sensitivity and specificity compared to hysteroscopy and avoids an unnecessary invasive procedure for many patients. SIS is recommended as the next test after an inconclusive transvaginal ultrasound for evaluating abnormal uterine bleeding.
hysteroscopy is a procedure with a very rare incidence of major side effects . a thorough knowledge of how to tackle them is must for anyone practicing hysteroscopy......
1) The document summarizes various gynecological surgical emergencies including acute vaginal bleeding, pelvic pain, infections, and post-operative complications.
2) It describes ovarian torsion in detail including causes, pathophysiology, signs and symptoms, diagnosis, and management focusing on the importance of detorsion to preserve ovarian tissue.
3) It also outlines the diagnosis and treatment of potentially life-threatening complications like necrotizing fasciitis, emphasizing the need for immediate surgical debridement and broad-spectrum antibiotics to manage this infection.
A 43-year-old male presented with a painful swelling above his right groin after being hit by a bull's horn one week prior. Imaging showed a hernial defect above the right inguinal region. As the patient was stable, he underwent a delayed laparoscopic repair of the defect using polypropylene sutures. Bullhorn injuries can cause traumatic abdominal wall hernias through direct blunt force. Delayed elective repair is appropriate for stable patients. Laparoscopic anatomical tissue repair is a valid option for small defects without hernia sac formation.
Retained products of conception dr.mohamed SolimanMohamed Soliman
1. Retained products of conception (RPOC) refers to incomplete evacuation of placental or trophoblastic tissue in the endometrial cavity after abortion, delivery, or cesarean section.
2. Ultrasound is first-line for diagnosis and may show an echogenic endometrial mass with low-resistance, high-velocity blood flow. Thickened endometrium (>10mm) or intrauterine fluid also suggest RPOC.
3. Differential diagnosis includes uterine atony, blood clots, or arteriovenous malformation. Presentation involves delayed bleeding or endometritis. Expectant management is appropriate for minimal vascularity; medication or surgery is
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.
This document discusses adnexal torsion in adolescents. It defines adnexal torsion and notes that it most commonly affects ovaries in females aged 10-20 years due to hormonal influences. Ultrasound is the preferred imaging method and can show signs like ovarian edema and twisted vascular pedicles. Emergent laparoscopy is the standard treatment to detorse the ovary, which often remains viable even if initially discolored. Oophoropexy may be considered in cases of recurrent torsion. The conclusion emphasizes that adnexal torsion should be considered in adolescent abdominal pain and that preservation of ovarian tissue is prioritized.
This study assessed the efficacy of bilateral uterine artery chemoembolization with methotrexate for treating cesarean scar pregnancies (CSPs). Forty-six women with CSPs underwent this procedure. It was found to be a safe and effective treatment, with 45 of 46 patients successfully treated. Complications were mainly fever and pain, which were alleviated with treatment. All patients recovered normal menstruation after treatment. This procedure caused less morbidity than current CSP treatment approaches.
This document provides an overview of pancreatic trauma, including relevant anatomy, epidemiology, etiology, presentation, diagnosis, and management. Some key points:
- The pancreas is protected by surrounding structures but can still be injured, especially through penetrating trauma or direct blunt force from seatbelts.
- Pancreatic injuries are often classified based on their cause and location. CT scans and ERCP can help diagnose and determine the severity of ductal injuries.
- Most patients with pancreatic trauma have additional internal injuries. Mortality rates are around 20%.
- Mild injuries can be managed conservatively but more severe injuries involving ducts or the pancreatic head may require surgery like distal pancreatectomy or exploration
EVIDENCE BASED PRACTICAL TIPS FOR OFFICE HYSTEROSCOPY BY DR SHASHWAT JANI DR SHASHWAT JANI
This document provides evidence-based practical tips for office hysteroscopy. It discusses appropriate patient selection, instrumentation, techniques such as the vaginoscopic approach, use of distension media, and tips for managing complications. Key recommendations include using the smallest possible hysteroscope, considering NSAIDs for analgesia, and addressing any contraindications to minimize risks. Office hysteroscopy is presented as a generally safe procedure that can provide diagnostic and some operative capabilities when performed properly.
This document discusses complications that can occur during and after hysteroscopy procedures. It begins by stating that the overall complication rate is around 2% according to studies. It then discusses specific direct complications like cervical injury, uterine perforation, hemorrhage, infection, and thermal damage. Indirect complications include reactions to anesthesia or distention media. The document provides details on managing three main complications - uterine perforation, hemorrhage, and injury to other organs like the bowel or bladder. It emphasizes the importance of proper training, experience, instruments and use of distention media like CO2 to reduce complications.
This document provides information about hysteroscopy, including:
- A hysteroscope is an endoscope used to visualize the uterine cavity and perform procedures.
- It describes the historical development of hysteroscopy from the 19th century to modern techniques.
- The types of hysteroscopes and instrumentation used are outlined, including distention media, electrodes, sheaths, and cameras.
- The document discusses the procedures, indications, contraindications and complications of diagnostic and operative hysteroscopy.
The document discusses the history and management of penetrating abdominal wounds. It notes that in the 19th century such wounds were managed non-operatively with high morbidity and mortality rates, but that experience from wars led to more aggressive operative management. In 1960, Shaftan developed a selective approach of conservatism for stab wounds. The document focuses on abdominal stab wound exploration as a technique for determining if laparotomy is needed in asymptomatic patients, noting its safety, speed and cost-effectiveness. It provides details on patient selection, contraindications, anesthesia, equipment, positioning and technique for abdominal stab wound exploration.
In this presentation nuclear medicine application in nephrology is explained in detail based on UPTODATE evidence based recommendations.
Different examples were given.
In this PPT I am discussing about post-operative fever on POD#3. This is commonly due to catheter associated urinary tract infection- CA-UTI. The cause is keeping urinary catheter too long. I am discussing about how to diagnose this problem and how to manage it. you can watch all my teaching videocasts in the following links:
surgicaleducator.blogspot.com
This document provides guidelines for nursing management of patients with nephrostomy tubes. Nephrostomy tubes are inserted through the skin into the kidney to provide drainage for various conditions. Tube types include pigtail and wide bore catheters. Care involves irrigation, securing tubes, monitoring output, and educating patients prior to discharge. Nurses must follow sterile technique, check tubes regularly for patency and complications, and maintain fluid balances. Medical orders are required for irrigation and tube removal.
This document outlines a study protocol to evaluate a novel transvaginal surgical approach for repairing caesarean section scar defects. The study will recruit 60 symptomatic women to undergo transvaginal repair involving endometrial curettage of the scar defect cavity and suturing of the defect. Patients will be followed for 6 months with clinical and ultrasound evaluations at regular intervals to assess outcomes. The goal is to evaluate if this approach can effectively repair scar defects while avoiding complete excision of healthy myometrium.
(Albayrak, 2011) post partum haemorrhage from the lower uterine segment secon...dadupipa
This document describes the successful use of intrauterine Foley balloon tamponade for managing postpartum haemorrhage from the lower uterine segment secondary to placenta praevia or accreta during caesarean delivery. Fifteen women experiencing heavy bleeding unresponsive to other conservative measures had a Foley catheter inserted into the uterus with its balloon inflated. This achieved haemostasis in all cases. The balloon was left in place for 18-24 hours then gradually removed. This technique provides an effective conservative option before more invasive interventions for controlling lower uterine segment bleeding during caesarean delivery complicated by placenta praevia or accreta.
This document discusses first trimester bleeding, which occurs in 20-40% of pregnancies. The main causes are miscarriage (95%), ectopic pregnancy (2%), hydatidiform mole (<1%), and vanishing twin. Diagnosis involves history, examination, ultrasound to determine if the pregnancy is intrauterine, extrauterine, viable, or nonviable. Common ultrasound findings for miscarriage include no fetal heartbeat, subchorionic bleeding, or an empty gestational sac over 20mm. Ectopic pregnancies may appear as an adnexal mass. Rare causes are molar pregnancies, appearing on ultrasound as a "snowstorm" pattern of cysts in the placenta. First trimester bleeding
Sonohysterography (SIS) involves inserting a catheter into the uterus and using saline solution to distend the uterine cavity during an ultrasound exam. It allows visualization of the endometrial cavity and identification of polyps, submucous fibroids, and other causes of abnormal uterine bleeding. Studies show SIS has high sensitivity and specificity compared to hysteroscopy and avoids an unnecessary invasive procedure for many patients. SIS is recommended as the next test after an inconclusive transvaginal ultrasound for evaluating abnormal uterine bleeding.
hysteroscopy is a procedure with a very rare incidence of major side effects . a thorough knowledge of how to tackle them is must for anyone practicing hysteroscopy......
1) The document summarizes various gynecological surgical emergencies including acute vaginal bleeding, pelvic pain, infections, and post-operative complications.
2) It describes ovarian torsion in detail including causes, pathophysiology, signs and symptoms, diagnosis, and management focusing on the importance of detorsion to preserve ovarian tissue.
3) It also outlines the diagnosis and treatment of potentially life-threatening complications like necrotizing fasciitis, emphasizing the need for immediate surgical debridement and broad-spectrum antibiotics to manage this infection.
A 43-year-old male presented with a painful swelling above his right groin after being hit by a bull's horn one week prior. Imaging showed a hernial defect above the right inguinal region. As the patient was stable, he underwent a delayed laparoscopic repair of the defect using polypropylene sutures. Bullhorn injuries can cause traumatic abdominal wall hernias through direct blunt force. Delayed elective repair is appropriate for stable patients. Laparoscopic anatomical tissue repair is a valid option for small defects without hernia sac formation.
Retained products of conception dr.mohamed SolimanMohamed Soliman
1. Retained products of conception (RPOC) refers to incomplete evacuation of placental or trophoblastic tissue in the endometrial cavity after abortion, delivery, or cesarean section.
2. Ultrasound is first-line for diagnosis and may show an echogenic endometrial mass with low-resistance, high-velocity blood flow. Thickened endometrium (>10mm) or intrauterine fluid also suggest RPOC.
3. Differential diagnosis includes uterine atony, blood clots, or arteriovenous malformation. Presentation involves delayed bleeding or endometritis. Expectant management is appropriate for minimal vascularity; medication or surgery is
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.
This document discusses adnexal torsion in adolescents. It defines adnexal torsion and notes that it most commonly affects ovaries in females aged 10-20 years due to hormonal influences. Ultrasound is the preferred imaging method and can show signs like ovarian edema and twisted vascular pedicles. Emergent laparoscopy is the standard treatment to detorse the ovary, which often remains viable even if initially discolored. Oophoropexy may be considered in cases of recurrent torsion. The conclusion emphasizes that adnexal torsion should be considered in adolescent abdominal pain and that preservation of ovarian tissue is prioritized.
Laparoscopic ovarian surgery can be used to manage most ovarian abnormalities. Key steps in laparoscopic ovarian cystectomy include aspirating cyst contents, stripping the cyst capsule from the ovarian cortex, and extracting the capsule. It is important to avoid injury to nearby structures like the ureter and completely remove the cyst to evaluate for early carcinoma. Outcomes are better when the ovary can be preserved through cystectomy rather than full oophorectomy. Teratomas require especially careful removal of all contents to prevent chemical peritonitis.
UPJ obstruction is most commonly caused by intrinsic stenosis of the proximal ureter. It occurs in approximately 1 in 500 live births, with males and left kidneys more commonly affected. Ultrasound is used to diagnose and monitor hydronephrosis, while diuretic renography can determine if obstruction is present and assess renal function. Surgical correction via pyeloplasty is indicated if renal function is impaired or decreasing, with the Anderson-Hynes dismembered pyeloplasty being the most common procedure performed. Non-operative management with antibiotics may be appropriate if drainage is adequate on functional studies.
This document describes a case of a 12-year-old female who presented with abdominal pain and signs of peritonitis. She underwent an exploratory laparotomy which revealed a Meckel's diverticulum with gastric mucosa and a jejunal perforation. She had a complicated postoperative course requiring a second surgery. Meckel's diverticulum is a common congenital abnormality caused by incomplete vitelline duct obliteration. It can contain heterotopic gastric or pancreatic mucosa and commonly presents in children with GI bleeding. Surgical resection is often required for complications like perforation or obstruction.
This document provides information on elective splenectomy procedures. It discusses the indications for elective splenectomy, including hematological diseases causing splenomegaly or hypersplenism. The document outlines techniques for performing an open splenectomy, including ligating the splenic artery and avoiding injuries to nearby structures. It emphasizes preventing postoperative hemorrhage and sepsis. Accessory spleens should also be sought out and removed before closure to avoid therapeutic issues.
Antenatal Hydronephrosis, Hydronephrosis in Child Treatment, Delhi - Dr. Pras...Dr. Prashant Jain
With easy availability of ultrasound screening and improvement in expertise, hydronephrosis is now a very frequently diagnosed problem reported in 1 to 5% of all pregnancies. This has enabled us to have a better understanding of the natural course of the problem and early intervention before it results in permanent renal damage.
The distinction between urinary tract obstruction and dilatation remains a challenging problem for clinicians. Still there are no definite guidelines and protocols for evaluation of antenatal hydronephrosis (ANH).
1) Postoperative pancreatic fistulas can lead to severe complications and increased mortality following pancreatic surgery. Conservative treatment is successful in about 80% of cases, but 20% require reoperation.
2) The authors conducted a study of 445 patients who developed a postoperative pancreatic fistula (POPF) after pancreatic surgery. They employed an early, aggressive treatment approach using interventional radiology techniques like drain insertion to manage POPFs conservatively.
3) Their approach was successful in managing 95.7% of POPFs conservatively and preventing severe complications and mortality, with only 3 patients requiring reoperation.
PUJ obstruction is a restriction of urine flow from the renal pelvis to the ureter. It can be congenital or acquired, with congenital being one of the most common causes of antenatal hydronephrosis. Diagnosis involves ultrasonography, VCUG, diuretic renography and other imaging modalities to determine severity and presence of associated issues. Treatment depends on severity but typically involves surgical intervention like open or laparoscopic pyeloplasty to resect and reanastomose the obstructed segment if drainage is significantly impaired or renal growth is poor. Postoperative follow up with imaging is important to monitor repair.
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This document discusses kidney transplantation in patients with abnormal bladders. It begins by defining normal bladder function and various types of abnormal bladders. Evaluation of the bladder includes history, exam, imaging, and urodynamics. Goals of management are normal drainage and storage with low pressure and voluntary emptying. Native bladder is preferred for graft placement but augmented bladders can also be used. Post-operative care involves bladder training and antibiotics to prevent infection while allowing bacteriuria. Complications can include electrolyte issues, mucus production, and stones depending on the type of augmentation.
This document discusses various obstetric and gynecologic causes of an acute abdomen in pregnant and non-pregnant patients. It describes conditions such as abruptio placentae, ectopic pregnancy, rupture of the uterus, and torsion of the uterus. For each condition, it outlines the clinical features, diagnostic approaches, and principles of treatment. The document provides a comprehensive overview of potential causes of acute abdominal pain in obstetric and gynecologic patients.
This document provides an overview of intravenous urography (IVU), including indications, contraindications, technique, projections, and modifications. IVU involves intravenous injection of contrast medium to visualize the urinary tract. It is declining in use due to newer modalities like CT and MRI, adverse effects of contrast, and cost. The document outlines patient preparation, standard projections including nephrogram, 5-minute, compression, and post-void films. It also discusses non-routine projections, contrast agents, and radiation protection. Complications and aftercare are briefly mentioned.
In 1916, Schloffer performed the first splenectomy for idiopathic thrombocytopenic purpura (ITP) after his student Paul Kaznelson hypothesized that platelet destruction in ITP occurred in the spleen. Their first patient treated with splenectomy showed dramatic improvement. Splenectomy is now an established treatment for chronic ITP when patients have relapsed or have severe refractory thrombocytopenia. It results in complete or partial response rates of 66-72% in adults and 72% in children, with relapse rates of 15%. Predictors of response to splenectomy are not well established.
A 45-year-old alcoholic man presented with an abdominal mass. A pseudocyst is a fluid-filled sac that can develop after pancreatitis as the pancreas digests itself. Pseudocysts are usually identified on imaging and distinguished from tumors using cyst fluid analysis. Large or long-lasting pseudocysts may require drainage through endoscopic or surgical procedures into the stomach or small intestine to prevent complications, with success rates over 85% depending on the approach.
1) Acute appendicitis is inflammation of the appendix that is most commonly seen in teenagers and young adults. It is usually caused by a blockage in the appendix that increases pressure and causes pain.
2) Symptoms include abdominal pain that starts around the belly button and shifts to the lower right side, nausea, loss of appetite, fever, and tenderness in the lower right abdomen.
3) Diagnosis is usually made clinically but imaging like ultrasound or CT scan can help if the diagnosis is uncertain. The Alvarado score is also used to evaluate the likelihood of appendicitis.
1. Antenatal hydronephrosis is a common prenatal finding that requires postnatal evaluation to identify potential kidney abnormalities.
2. Most cases of antenatal hydronephrosis are transient and resolve without intervention, while others may indicate issues like urinary tract obstruction that require treatment.
3. Postnatal evaluation includes ultrasound, voiding cystourethrogram, diuretic renography and other tests to determine the severity and cause of hydronephrosis and assess kidney function.
This document discusses kidney transplantation in patients with abnormal bladders. It begins by noting that structural urological abnormalities can lead to end-stage renal disease in 15-30% of patients. An abnormal bladder is no longer a contracontraindication for transplantation. The document then discusses different types of abnormal bladders and how they are evaluated. Urodynamic testing assesses bladder capacity and function. The goals for managing an abnormal bladder are outlined. General principles and issues related to pre-transplant, peri-transplant, and post-transplant management are covered. Complications are also reviewed. The conclusion is that with proper knowledge and management, transplantation can be successful even in patients with abnormal bladders.
1) Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a serious condition that can lead to maternal death if left untreated.
2) Risk factors for ectopic pregnancy include previous pelvic infections, IUD use, infertility treatments, and previous ectopic pregnancies or pelvic surgeries.
3) Clinical presentation varies from acute abdominal pain and shock due to tubal rupture to more subtle symptoms like abdominal pain and vaginal bleeding. Diagnosis is confirmed through transvaginal ultrasound and tests of beta-hCG levels and progesterone.
4) Treatment depends on severity but may include medication with methotrexate
Similar to Acs0905 Gynecologic Considerations For The General Surgeon (20)
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.
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.
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.
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.