This document discusses a case of a 46-year-old male who presented with abdominal pain after a laparoscopic cholecystectomy and was found to have a bile leak. An ERCP revealed a leak from the cystic duct stump that was treated with stent placement. Bile duct injuries are a risk of cholecystectomy and can be classified in various ways. Diagnosis involves imaging studies and treatment aims to redirect bile flow away from leak sites.
The document summarizes key information about spinal nerves and the brachial plexus. It describes:
- The anatomy of spinal nerves, including their dorsal and ventral roots and formation of rami.
- The 31 pairs of spinal nerves and their names based on point of issue from the spinal cord.
- How ventral rami branch and join to form the cervical, brachial, lumbar, and sacral plexuses.
- The major nerves of the brachial plexus and their motor and sensory innervation, including the axillary, radial, musculocutaneous, ulnar, and median nerves.
- Common injuries to spinal nerves and the brachial plexus
This document discusses a case of a 46-year-old male who presented with abdominal pain after a laparoscopic cholecystectomy and was found to have a bile leak. An ERCP revealed a leak from the cystic duct stump that was treated with stent placement. Bile duct injuries are a risk of cholecystectomy and can be classified in various ways. Diagnosis involves imaging studies and treatment aims to redirect bile flow away from leak sites.
The document summarizes key information about spinal nerves and the brachial plexus. It describes:
- The anatomy of spinal nerves, including their dorsal and ventral roots and formation of rami.
- The 31 pairs of spinal nerves and their names based on point of issue from the spinal cord.
- How ventral rami branch and join to form the cervical, brachial, lumbar, and sacral plexuses.
- The major nerves of the brachial plexus and their motor and sensory innervation, including the axillary, radial, musculocutaneous, ulnar, and median nerves.
- Common injuries to spinal nerves and the brachial plexus
1) Patients with septic shock are normovolemic despite increased cardiac output and low peripheral resistance due to a hyperdynamic state induced by sepsis. A low systemic vascular resistance is useful for diagnosis.
2) Superficial spreading melanoma is more common on the trunk/arms/thighs in white races, starting as an asymmetric macule with irregular borders and color variation that penetrates quickly. Resection margins are 1cm for lesions <1mm, 2cm for 1-4mm, and 3cm for >4mm.
3) For cardiac tamponade diagnosis, listening to breath sounds is most useful to differentiate from tension pneumothorax, which presents with absent breath sounds over the affected hemith
The document discusses the timing of administering prophylactic antibiotics before surgery. The first dose should be given within 60 minutes before incision for most surgeries, and within 120 minutes for fluoroquinolones or vancomycin. For cardiothoracic surgery specifically, antibiotics are recommended for up to 72 hours to prevent deep sternal infections.
The document discusses topics related to infection prevention including:
1. The proper timing for prophylactic antibiotic dosing is one hour before surgery.
2. The normal wound infection rate is 2-5% and increases to over 30% with certain risk factors.
3. Eradication of Staphylococcus epidermis is difficult due to its ability to form biofilms through secretion of exoslime, which allows antibiotics to not penetrate the biofilm.
The document discusses post-operative wound infection rates based on wound classification, nerves at risk of injury during laparoscopic inguinal hernia repair, and anatomical areas to avoid when using staples. It also describes the typical paths of perineal fistulas in Crohn's disease based on the location of the external opening.
This document provides notes on breast disease compiled by a surgical resident over 5 years. It summarizes key points about ductal carcinoma in situ (DCIS), including treatment with lumpectomy and radiation or mastectomy. It notes DCIS has a high cure rate of 94-100% and tamoxifen can decrease recurrence rates but not survival. For lobular carcinoma in situ (LCIS), it summarizes the increased lifetime risk of developing invasive cancer of both breasts.
This document discusses the anatomy, physiology, and various motility disorders of the esophagus. It covers topics like esophageal studies, manometry, pH monitoring, achalasia, GERD, and Barrett's esophagus. Treatment options are provided for various esophageal conditions, including dilation, botulinum toxin injections, myotomy, fundoplication, and surveillance for Barrett's esophagus. Surgical procedures for motility disorders and reflux like Heller myotomy, Nissen fundoplication, and Collis gastroplasty are also outlined.
This document contains a list of topics related to clinical management and basic science concepts in various medical disciplines including ABSITE, body as a whole, gastrointestinal, cardiovascular/respiratory, and others. Some examples of topics listed include treatment of hyperacute renal transplant rejection, characteristics of von Willebrand's disease, diagnosis of pancreatic abscess, treatment of neurogenic shock, and characteristics of bacterial endotoxins.
The document discusses the results of a study on the impact of climate change on global wheat production. Researchers found that rising temperatures will significantly reduce wheat yields across different regions of the world by the end of the century. Under a high emissions scenario, wheat production is projected to decrease between 6-27% globally depending on the region, posing substantial risks to global food security.
1) Patients with septic shock are normovolemic despite increased cardiac output and low peripheral resistance due to a hyperdynamic state induced by sepsis. A low systemic vascular resistance is useful for diagnosis.
2) Superficial spreading melanoma is more common on the trunk/arms/thighs in white races, starting as an asymmetric macule with irregular borders and color variation that penetrates quickly. Resection margins are 1cm for lesions <1mm, 2cm for 1-4mm, and 3cm for >4mm.
3) For cardiac tamponade diagnosis, listening to breath sounds is most useful to differentiate from tension pneumothorax, which presents with absent breath sounds over the affected hemith
The document discusses the timing of administering prophylactic antibiotics before surgery. The first dose should be given within 60 minutes before incision for most surgeries, and within 120 minutes for fluoroquinolones or vancomycin. For cardiothoracic surgery specifically, antibiotics are recommended for up to 72 hours to prevent deep sternal infections.
The document discusses topics related to infection prevention including:
1. The proper timing for prophylactic antibiotic dosing is one hour before surgery.
2. The normal wound infection rate is 2-5% and increases to over 30% with certain risk factors.
3. Eradication of Staphylococcus epidermis is difficult due to its ability to form biofilms through secretion of exoslime, which allows antibiotics to not penetrate the biofilm.
The document discusses post-operative wound infection rates based on wound classification, nerves at risk of injury during laparoscopic inguinal hernia repair, and anatomical areas to avoid when using staples. It also describes the typical paths of perineal fistulas in Crohn's disease based on the location of the external opening.
This document provides notes on breast disease compiled by a surgical resident over 5 years. It summarizes key points about ductal carcinoma in situ (DCIS), including treatment with lumpectomy and radiation or mastectomy. It notes DCIS has a high cure rate of 94-100% and tamoxifen can decrease recurrence rates but not survival. For lobular carcinoma in situ (LCIS), it summarizes the increased lifetime risk of developing invasive cancer of both breasts.
This document discusses the anatomy, physiology, and various motility disorders of the esophagus. It covers topics like esophageal studies, manometry, pH monitoring, achalasia, GERD, and Barrett's esophagus. Treatment options are provided for various esophageal conditions, including dilation, botulinum toxin injections, myotomy, fundoplication, and surveillance for Barrett's esophagus. Surgical procedures for motility disorders and reflux like Heller myotomy, Nissen fundoplication, and Collis gastroplasty are also outlined.
This document contains a list of topics related to clinical management and basic science concepts in various medical disciplines including ABSITE, body as a whole, gastrointestinal, cardiovascular/respiratory, and others. Some examples of topics listed include treatment of hyperacute renal transplant rejection, characteristics of von Willebrand's disease, diagnosis of pancreatic abscess, treatment of neurogenic shock, and characteristics of bacterial endotoxins.
The document discusses the results of a study on the impact of climate change on global wheat production. Researchers found that rising temperatures will significantly reduce wheat yields across different regions of the world by the end of the century. Under a high emissions scenario, wheat production is projected to decrease between 6-27% globally depending on the region, posing substantial risks to global food security.
The most common reason for arteriovenous (AV) graft failure is venous obstruction caused by intimal hyperplasia. Early failures are usually due to technical issues, while late failures are usually caused by intimal hyperplasia developing on the venous side of the graft.
Lower extremity fasciotomies involve making two incisions. The first incision is made posteriorly along the medial tibia to open the superficial posterior space. The soleus muscle is then longitudinally incised to open the deep posterior space. A second incision is made anteriorly along the lateral fibula to access the anterior and lateral muscle compartments. Injury to the superficial peroneal nerve during this procedure would result in decreased ability
This document discusses the cardiac output and metabolic needs of severely burned patients. It notes that cardiac output decreases for the first 24-48 hours after a massive burn, then increases. It recommends caloric needs of 25 kcal/kg/day plus an additional 30 kcal for each percent of total body surface area burned, and protein needs of 1 g/kg/day plus an additional 3 g for each percent burned. It also notes that burned wounds use glucose in an obligatory fashion. The document then provides an example fluid resuscitation calculation using the Parkland formula for a patient with a 35% total body surface area flame burn.