Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
All you need to know about peri-ampullary cancer
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Timely diagnosis and proper treatment in a way towards cure
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
All you need to know about peri-ampullary cancer
Periampullary cancer is a common diagnosis with patient with progressive jaundice in northern part of India
Timely diagnosis and proper treatment in a way towards cure
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
3. Anatomy
• The most
common anomaly
of splenic
embryology is the
accessory spleen.
• 80% in the splenic
hilum and
vascular pedicle
4. • It lies in the left hypochondrium
between the gastric fundus and the
left hemidiaphragm, with its long
axis lying along the tenth rib.
• The hilum sits in the angle
between the stomach and the
kidney and is in contact with the
tail of the pancreas.
10. LYMPHATIC DRAINAGE
• The lymphatic drainage comprises efferent
vessels in the white pulp that run with the
arterioles and emerge from nodes at the
hilum.
• These nodes and lymphatics drain via
retropancreatic nodes to the coeliac nodes.
11. Histology
Red pulp (75%):
Large numbers of venous sinuses
that drains into splenic veins
Sinuses is surrounded & separated by
reticulum where the macrophages
lies
Serves as a dynamic filtration system
where macrophages remove
the microorganisms, cellular debris,
Ag & Ab complexes and senescent
erythrocytes.
White pulp:
– Periarticular lymphatic sheaths
– Comprised T lymphocytes and
intermittent aggregations of
B lymphocytes or lymphoid
follicles.
12.
13. FUNCTIONS
1. Filtration- Macrophages in the reticulum capture cellular and non-
cellular material from the blood and plasma.
(removal of effete platelets & RBC, Iron is removed from the
degraded hemoglobin, pneumococci)
1. Host defense- The spleen processes foreign antigens and is the
major site of specific immunoglobulin M (IgM) production.
The non-specific opsonins, properdin and tuftsin, are synthesized.
1. Storage
2. Cytopoiesis
14. • Pitting:
• Particulate inclusions from red cells are removed, and
the repaired red cells are returned to the circulation.
• These include Howell–Jolly and Heinz bodies, which
represent nuclear remnants and precipitated
hemoglobin or globin subunits, respectively.
15. • Most common indication is trauma to
spleen, whether iatrogenic or otherwise
• Most common elective splenectomy is ITP
• followed by hereditary spherocytosis ---->
autoimmune hemolytic anemia ----->
thrombotic thrombocytopenic purpura.
INDICATIONS FOR SPLENECTOMY
17. B. Platelet Disorders:
1. Idiopathic Thrombocytopenic purpura (ITP)
2. Thrombotic thrombocytopenic purpura (TTP)
1. White Blood Disorders:
1. Leukemias
2. Lymphomas
INDICATIONS FOR SPLENECTOMY
18. D. Bone Marrow Disorders:
1. Myelofibrosis
2. Chronic myeloid leukemia
3. Acute myeloid leukemia
4. Chronic myelomonocytic
leukemia
5. Essential thrombocythemia
6. Polycythemia vera
INDICATIONS FOR SPLENECTOMY
19. E. Miscellaneous disorders:
Infections/abscess
Storage disease/infiltrate disorder
a) Gaucher’s disease
b) Niemann-Pick disease
c) Amyloidosis
a) Felty’s syndrome-rheumatoid arthritis, splenomegaly, and
abnormally low WBC count.
b) Sarcoidosis
c) Cysts & tumors
d) Portal hypertension
e) Splenic artery aneurysm
INDICATIONS FOR SPLENECTOMY
21. SPLENIC ARTERY EMBOLIZATION
• Advantages:
▫ a) Reduced operative blood loss from
devascularized spleen
▫ b) Reduces spleen size for easier dissection and
removal.
• Disadvantages:
Acute left sided pain
• Currently no consensus
22. VACCINATION
Common bacteria:
a) Streptococcus pneumoniae
b) Hemophilus influenzae type B
c) Meningococcus
a) Vaccination against encapsulated bacteria 2 wks before
surgery.
b) In emergency splenectomy, trauma, give vaccine as
soon as possible.
c) Booster injections every 5 – 6 yrs regardless of the
reason for splenectomy for pneumococcal
d) Annual influenza immunization
23. DEEP VENOUS THROMBOSIS
PROPHYLAXIS
• Specially in splenectomy for myeloproliferative
disorders (MPD).
• 40% risk for PVT (portal vein thrombosis)
• Anticoagulation ---> keys for successful tx
• Prophylaxis: --> subcutaneous heparin (5000U)
30. CLINICAL PRESENTATION
• Kehr’ Sign: Referred pain in Lt shoulder , hyperesthesia from
diaphragmatic irritation
• Balance sign: Shifting dullness on Right side (free blood) +
Fixed Dullness on Left side (clots, hematoma)
• Cullen’s sign: (late) Bluish discoloration around the umbilicus
31. The diagnosis is
confirmed by
CT scan
(hemodynamic
stability)
OR
exploratory
laparotomy
(hemodynamic
instability)
U/S, CT replaced "DIAGNOSTIC
PERITONEAL LAVAGE" (used
when there's no time)
INITIAL INVESTIGATION – USG ( FAST)
32. Organ Injury Scaling-American Association
of the Surgery of Trauma (OIS-AAST)
Grade Injury Description
I Haematoma: Subcapsular, <10% surface area
Laceration: Capsular tear, <1cm parenchymal depth
II Haematoma: Subcapsular, 10-50% surface area
Intraparenchymal, <5cm diameter
Laceration: 1-3cm parenchymal depth not involving a parenchymal
vessel.
III Haematoma: Subcapsular, >50% surface area or expanding.
Ruptured subcapsular or parenchymal haematoma.
Intraparencymal haematoma >5cm
Laceration: >3cm parenchymal depth or involving trabecular vessels
IV Laceration: Laceration of segmental or hilar vessels producing major
devascularization (>25% of spleen)
V Laceration: Completely shattered spleen
Vascular: Hilar vascular injury which devascularized spleen
33. 70%
CONSERVATIVE
TREATMENT
• 3) Absence of other clear indications for exploratory
laparotomy or associated injuries requiring surgical
intervention.
• 4) Absence of associated health conditions that carry an
increased risk for bleeding
36. Capsular tears of the
spleen can be controlled
by compression only
OR
By using topical
hemostatic agents.
37. Deeper lacerations can be controlled
with horizontal absorbable mattress
sutures.
SPLENORRHAPHY
38. Major lacerations involving less than 50% of the splenic
parenchyma and not extending into the hilum can be
treated by segmental or partial splenic resection.
Resection is indicated only if the patient is stable and no other
major injuries are present.
PARTIAL SPLENECTOMY
39. More extensive injuries involving the
hilum or the central portion of the spleen…
SPLENECTOMY
40. Changes in blood after Splenectomy
• Appearance of Howell-Jolly bodies & siderocytes
• Leukocytosis
• Increased platelet counts
41. COMPLICATIONS OF SPLENECTOMY
• Pulmonary complications:
▫ a) Left lower lobe atelectasis (most common)
▫ b) Pleural effusion
▫ c) Pneumonia
• Hemorrhage ----->subphrenic hematoma
• Infectious complication: Subphrenic abscess
42. • Pancreatic complications: due to intra-op
trauma to tail of pancreas
▫ a) Pancreatitis
▫ b) Pseudocyts
▫ c) Pancreatic fistula
• Thromboembolic phenomena (5-10%)
COMPLICATIONS OF SPLENECTOMY
43. • lifetime risk of severe infection (1-5%)
• incidence similar among children & adult but
mortality is higher in children.
• mortality is highest in hematologic conditions
• infection to encapsulated bacteria or parasites
▫ 1. Streptococcus pneumoniae (most common infection
50-90%)
▫ 2. Haemophilus influenzae type B
▫ 3. Meningococcus
▫ 4. Grp A streptococcus
COMPLICATIONS OF SPLENECTOMY-
Overwhelming Postsplenectomy
Infection (OPSI)
46. CLINICAL PRESENTATIONS
• Fever
• Abdominal Pain
• Shoulder pain (Involvement of the diaphragmatic pleura )
• Pleuritic chest pain
• General malaise
• Dyspeptic symtoms
47. IMAGING
• Plain X-RAY- elevated lt.copula of diaphragm
indentation of fundic air bubble
Obliteration of Lt. psoas shadow
• US
• CT
• MRI
48. COMPUTED TOMOGRAPHY
• NECT :
- Low attenuation, ill-defined lesion within
splenic
Parenchyma
• CECT:
- Low attenuation, nonenhancing complex fluid
collection
May extend to subcapsular location
49. NECT
Nonenhanced CT scan shows a 6-
cm hypoattenuating mass within
the spleen (large arrow), with
inflammatory soft tissue
stranding in the adjacent
extraperitoneal fat (small arrow)
50. Pyogenic splenic abscess on CECT.
Note low attenuation
abscess bulging splenic
parenchyma (arrow).
Pyogenic splenic abscess on
axial CECT.
Note thin septations within
abscess (arrows)
CECT