This document provides an overview of splenic injuries, including epidemiology, anatomy, evaluation, management, and guidelines. Key points include:
- The spleen is the most commonly injured organ in blunt abdominal trauma. Evaluation involves clinical exam, hematology tests, ultrasound, and CT scan to grade injuries.
- Management depends on hemodynamic stability and injury grade. Options include non-operative management with observation or angioembolization, or splenectomy/splenorrhaphy during surgery.
- Complications of splenic injuries and splenectomy include hemorrhage, infection, and post-splenectomy sepsis. Guidelines recommend attempting non-operative management for stable patients
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
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
URETHRAL INJURY- Trauma Surgery
#surgicaleducator #babysurgeon
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on URETHRAL INJURY- one more in Trauma Surgery. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about anatomy, classification, etio-pathogenesis, symptoms, signs, investigations, grading, treatment, complications, treatment algorithm and case vignettes of urethral injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of urethral injury and should also be able to institute immediate treatment to the patients if there is a need. The definitive urethroplasty should be done by a Urologist. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Types of Urethral injury, Mechanism of Urethral injury, Classification of Urethral injury, Symptoms of Urethral injury, Signs of Urethral injury,
Investigations for Urethral injury, Grading of Urethral Injury, Treatment for Urethral injury, Complications of Urethral Injury
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. History :
• Hippocrates in the fourth century bc was one of the
first to write on the spleen. He taught broadly on the
need for balance and equilibrium between the
patient and his environment.
• The great ancient Roman physician, surgeon and
philosopher Claudius Galen (129-216 AD) described
the spleen as “Plenum mysterii organum” or “the
organ full of mystery” as he struggled to elucidate its
function.
• In modern English, "to vent one's spleen" means to
vent one's anger, e.g. by shouting (BAD TEMPER)
4. • In 1893, Reigner published the first documented
successful splenectomy in the German literature.
• Operative mortality rates remained high until the
1950s
• Non operative care during this period was
predominantly fatal.
• With the widespread availability of computed
tomography surgeons began to focus on those
needing surgery and those who could be observed
safely.
5. Anatomy:
• Ovoid/wedge, usually purplish, pulpy mass
• Largest lymphoid organ, part of lymphoreticular system
• About size and shape of one’s fist
• Most vulnerable abdominal organ for traumatic injury
• Located in left upper quadrant or LHC
• Protected by lower thoracic cage
• Completely encircled and covered with peritoneum except
at hilum
6. 1×3×5×7×9×11 rule
• Size
1 inch thickness
3 inch wide
5 inch long
• Weight
7 ounce= 200gm.
• Related ribs
9-11 (along long axis of 10th rib)
11. • LIGAMENTS:
• Gastrosplenic Short gastric
vessels and left gastro-omental
vessels
• Splenorenal (lienorenal)
splenic vessels and tail of
pancreas
• Splenocolic in contact with
lower pole of spleen; at danger
during spleenectomy
14. Anatomical variations:
Accessory Spleens: splenenculi
• MC congenital anomaly
• 20 -30% incidence
• More incidence in
haematological diseases
• Found near hilum >80%, and
vascular pedicle
15. Locations in decreasing order:
• Hilum 80%
• Gastrocolic ligament
• Tail of pancreas
• Greater omentum
• Greater curvature of
stomach
• Splenocolic ligament
• Mesentry
• Lt spermatic cord/ broad
lig
16. Heterotaxy Syndromes:
• Disturbance in the usual right left distribution of thoracic
and abdominal organs.
• Occurs from early embryological developmental
disturbance.
• 2 types
• Right isomerism – Presents as CHD
• Left isomerism – Intestinal malrotation / Mid gut volvulus
17. Asplenia syndrome:
• Situs ambiguus with asplenia or
Ivemark syndrome is
characterized by an absent
spleen and duplication of right-
sided structures.
• Affecting males twice as
commonly as females.
18. Polysplenia syndrome:
• Multiple small spleens.
Also referred to as
situs ambiguus with
left isomerism.
• Equally in males and
females.
19. Physiology:
• Filter of Reticulo endothelial system.
• Humoral immunity, producing Ig M, Opsonins,
tufstin and properidin.
• Activation of complement system.
• Source of extramedullary hematopoiesis.
20. Splenic injury:
• Splenic injury most commonly occurs following blunt
trauma due to motor vehicle collisions
• Penetrating splenic trauma is less common than
blunt injury
• Iatrogenic traumatic injuries to the spleen can result
from surgical or endoscopic manipulation colon,
stomach, pancreas, Kidney.
• Primary mechanism is capsular tear, laceration from
retraction devices, or tension on the spleen during
manipulation of the colon
21. • Importance of history- victims located on the left
side of car
• Type & nature of weapon is important in penetrating
injuries
• Caliber of the gun
22. • Blunt Trauma: Rapid deceleration(MVA)
Direct blows to the abdomen(domestic violence, or leisure and play
activities such as bicycling)
• Penetrating Trauma
• Combination of above
explosive type injuries
warfare and civilian bombing
• Iatrogenic: Post procedure.
• Spontaneous Rupture: Malaria, IMN
24. Associated Injuries:
• Fracture Left lower ribs (30 %)
• Left sided hemothorax
• Left lung and diaphragm injury
• Left lobe liver injury
• Tail of pancreas injury
• Left kidney
• Left colonic injury
• Small bowel injury
25. Presentation
• Pain abdomen
• Shock
• Pain in lower part of chest on left side
• Abdominal distension
• Wound in left upper quadrent
• Symptoms of associated injuries
27. Examination: Per Abdomen
• External bruise may be seen in LHC
• Abdominal distension
• Contusions
• Decreased movement of LHC region
• Tenderness in LHC or all over abdomen
28. Signs:
• Kehr’s sign: Hans Kher, Germany
• Clot collected under left diaphragm irritates it
and the phrenic nerve( C3, C4) causing referred
pain in left shoulder 15 minutes after foot end
elevation
• Because the supraclavicular nerves have the
same cervical nerves origin as the phrenic
nerve, C3 and C4
30. SIGNS:
• BALLANCE SIGN: Charles
Alfred Ballance,UK
• Persistent dullness to
percussion in the left flank due
to coagulated blood
• shifting dullness to percussion
in the right flank due to fluid
blood
35. CECT Abdomen:
• Hemoperitoneum – Localized fluid collections around the
spleen (especially those with an elevated HU
measurement) are highly suggestive of hemoperitoneum.
• Briskly bleeding splenic lacerations may establish blood
density fluid throughout the abdomen.
• Hypodensity – Hypodense regions represent areas of
parenchymal disruption, intraparenchymal hematoma or
subcapsular hematoma.
• Contrast blush or extravasation – Contrast blush describes
hyperdense areas within the splenic parenchyma that
represent traumatic disruption or pseudoaneurysm of the
splenic vasculature. Active extravasation of contrast implies
ongoing bleeding and the need for urgent intervention
43. Management
Non-operative management of splenic injury (NOMSI)
• Conservative
• Interventional radiology: Splenic artery angio
embolization
Operative management
• Splenorraphy: procedure to preserve spleen done in
past, now replaced by NOMSI
• Splenectomy
44.
45. The standard criteria for NOM are:
• Hemodynamic stability/ readily stabilizable
• Lack of rebound and guarding
• Blood transfusions ≤ 4 units
• No lack of consciousness;
• Age <55 yrs.
46. NOMSI:
• Lower hospital cost
• Earlier discharge
• Avoiding nontherapeutic celiotomies (and
their associated cost and morbidity),
• Fewer intra-abdominal complications, and
• Reduced transfusion rates
47. • The only absolute indication for emergency
laparotomy is hemodynamic instability
• Complex/severe splenic injuries, age, preexistent
splenic diseases, number of units of transfused
blood, brain injuries are no longer considered
absolute contraindications for NOM
48. Splenic artery angioembolization:
• Adjunct to NOM of high grade injuries
1. Proximal splenic artery embolization: Distal
to dorsal pancreatic artery.
2. Distal selective embolization: High failure
rate.
Indicated in pts with evidence of active
extravasation of dye or pseudo aneurysm
49. Unsuccessful NOM: Occurs in
• Hemodynamic instability (systolic BP < 90 mmHg
despite adequate resuscitation)
• Age > 55 years old
• > 4 units of transfused blood to maintain a Hblevel
over > 10 g/dl
• Persistent leucocytosis
• The onset or aggravating sings of peritoneal
irritation
• Worsening imaging signs of splenic injury (repeated
US exams)-post-traumatic splenic defect
• Intra-abdominal compartment syndrome
(intravesical pressure > 20 cm H2O).
50. Splenorrhaphy:
• Parenchyma saving surgery of spleen
• The technique is dictated by the magnitude of
the splenic injury
1.superficial hemostatic strategies like fibrin
glue,gel foam,argon beem
coagulation,diathermy,topical thrombin
2.non absorbable suture repair
3.absorbable mesh wrap(poly galactin)
4.resectional debridement
51.
52.
53.
54.
55. Splenectomy: Partial
• Grade IV to V
splenic injury may
require anatomic
resection, including
ligation of the lobar
artery.
56. Total Splenectomy: Open
Position: Supine
GA
Inciscion: midline, Left
subcostal.
In large spleens and
trauma of other organs
full midline laparotomy
inciscions.
57. • Incision deepened to access the peritoneal cavity.
• Pack the 4 quadrant of the peritoneal cavity
• Suck out all free blood and clot
• Remove packs starting from least area of bleeding.
• Use your fingers to temporarily secure hemostasis at
the hilum(to prevent clamping of the tail of pancreas)
• Place the left hand on the spleen and draw it down to
divide the lieno renal ligament lying posteriorly
• Deliver the spleen into the abdominal incision
• Then a non-crushing clamp is applied at the hilum
safeguarding the pancreas
• Examine the spleen for grade of injury
• Ligate and divide; the short gastric arteries, left
gastroepiploic arteries. Slightly away from the stomach
with non absorbable suture
59. Ligation of the Splenic Pedicle:Anterior Approach
• Clamp, incise, and ligate the left part of the
gastrocolic ligament and the gastroepiploic
artery and vein.
• Locate the splenic artery at the superior
border of the body of the pancreas. Carefully
ligate the artery in continuity and doubly, with
ligatures being placed as distally as possible
60.
61. Ligation of the Splenic Pedicle:
Posterior Approach
• Hold the spleen medially.
• Divide the splenorenal, splenophrenic, and
splenocolic ligaments
• Lift the spleen outside the peritoneal cavity,
• being particularly careful with the tail of the
pancreas.
• Dissect rapidly and mobilize the bleeding
spleen immediately.
62. • Bleeding can be controlled by manually
compressing the splenic artery and vein and the
tail of the pancreas between the thumb and
index finger or with a non crushing clamp
• Ligate the arterial and venous branches close to
the hilum using 2–0 and 3–0 ligatures. Doubly
ligate the splenic artery
• Ligate the short gastric vessels.
• Remove the spleen and secure any bleeding
points.
• Close the abdominal wall.
68. OPSI
• A rapidly fatal infection following removal of spleen
• Incidence: 0.23-0.42% per year
• Most Occur 1st 2 years after splenectomy
• Lifetime risk <1-5%,
• Common organisms
• 1.S.pneumonia-50-90%
• 2.H.influenza
• 3.N.meningitis
• Mortality rate : 50-80%
69. • Mechanism-organism with polysaccharide
capsules need Opsonization with IGg3 or C3B
which attaches to special macrophages found
in the spleen
• Post splenectomy patients lack of
macrophages
• Starts with flu like symptoms, Meningitis or
sepsis
• Rapidly progressive 12-48 hrs
70. • Other organisms include: streptococcus
species, salmonella, Capnocytophaga
canimorous, Babesiosis.
High risk:
• children<5yrs old/>50 yrs,
• Splenectomy for Haemoglobiniopathies
[Thalasemeia, sickle cell a], Myelodysplasia,
malignancies.
71. Prevention:
Immunoprophylaxis:
• Vaccines aganst Strepto Pneumoniae [PPV23], H.Infl [H
influenza type B], Meningococcus
• Elective: At least 2 wks prior
• Emergency: PPV 23 immediate post op & Other two 2 wks
after surgery.
• [All 3 delayed for at least 2wks; because transient immune
suppression post op]
Antibody titre:
• No correlation between ab titre & clinical immunity
• Only in about 50% cases protective levels abs formed against
pneumococci
• Revaccination: CDC [united statescommunicable disese
control & prevention] to be revaccinated ppv 232-6 yrs after
splencetomy.
72. Antibiotic prophylaxis:
• Children: Until 5 yrs of age or at least 5 yrs
after surgery
• Penicillin, Amox, amoxyclav
• Adults: scanty evidence. Provided with
antibiotics to be taken at the sign of infection.
74. EAST Guidelines:
• Level 1
Patients who have diffuse peritonitis or who
are hemodynamically unstable after blunt
abdominal trauma should be taken urgently
for laparotomy.
75. EAST Guidelines:
• Level 2
1. A routine laparotomy is not indicated in the
hemodynamically stable patient without peritonitis
presenting with an isolated splenic injury.
2. The severity of splenic injury (as suggested by CT grade
or degree of hemoperitoneum), neurologic status, age
>55 and/or the presence of associated injuries are not
contraindications to a trial of nonoperative
management in a hemodynamically stable patient.
3. In the hemodynamically normal blunt abdominal
trauma patient without peritonitis, an abdominal CT
scan with intravenous contrast should be performed to
identify and assess the severity of injury to the spleen.
76. EAST Guidelines:
4. Angiography should be considered for patients
with AAST grade of greater than III injuries,
presence of a contrast blush, moderate
hemoperitoneum, or evidence of ongoing splenic
bleeding.
5. Non operative management of splenic injuries
should only be considered in an environment that
provides capabilities for monitoring, serial clinical
evaluations, and an operating room available for
urgent laparotomy.
77. EAST Guidelines:Level 3
1. After blunt splenic injury, clinical factors such as a persistent
systemic inflammatory response, increasing/persistent abdominal
pain, or an otherwise unexplained drop in Hb should dictate the
frequency of and need for follow-up imaging for a patient with
blunt splenic injury.
2. Contrast blush on CT scan alone is not an absolute indication for an
operation or angiographic intervention. Factors such as patient
age, grade of injury, and presence of hypotension need to be
considered in the clinical management of these patients.
3. Angiography may be used either as an adjunct to nonoperative
management for patients who are thought to be at high risk for
delayed bleeding or as an investigative tool to identify vascular
abnormalities such as pseudoaneurysms that pose a risk for
delayed hemorrhage.
4. Pharmacologic prophylaxis to prevent venous thromboembolism
can be used for patients with isolated blunt splenic injuries
without increasing the failure rate ofnonoperative management,
although the optimal timing of safe initiation has not been
determined.
78. Unanswered questions:???
1. Frequency of Hb measurements
2. Frequency of abdominal examinations
3. Intensity and duration of monitoring
4. Is there a transfusion trigger after which operative or angiographic
intervention should be considered?
5. Time to reinitiating oral intake
6. The duration and intensity of restricted activity (both in hospital
and after discharge)
7. Optimum length of stay for both the intensive care unit (ICU) and
hospital
8. Necessity of repeated imaging
9. Timing of initiating chemical deep venous thrombosis (DVT)
prophylaxis after a splenic injury
10. Should patients with severe injuries/or embolized injuries receive
postsplenectomy vaccines?
11. Is there an immunologic deficiency after splenic embolization?
79. Conclusion:
• Spleen is important organ, try to conserve it.
• Clinical examination has vital role in diagnosing and
treating splenic injuries.
• Activate the team as soon as splenic injury is
suspected.
• CECT is the investigation of choice.
• Hemodynamically unstable patient : Directly to OR
• Keep adequate blood ready before opening the
abdomen.
• Splenic artery embolisation has got definitive role.
80. • Enlarged spleens are more susceptible to injury.
• Hemodynamic instability is the only absolute
contraindication for NOMSI
• Left LL Pneumonia is the MCC following
splenectomy.
• OPSI is the devastating sequelae of asplenia.
• Prophylaxis against OPSI is must.
81. References:
1. Bailey & Love Short practice of Surgery,26th ed.
2. Sabiston Textbook of Surgery, 20th ed.
3. Schwartz Principles of Surgery, 9th ed.
4. Fischers Mastery of Surgery, Vol2, 6th ed.
5. Kirk’s General Surgical Operations, 6th ed.
6. Shakelford’s Surgery of Alimentary Tract, 7th ed.
7. EAST Guidelines.
8. Amith Ashish Surgery for PGMEE, 10th ed.
9. Velmahos GC, Chan LS, Kamel E, Murray JA, Yassa N, Kahaku
D, Berne TV, Demetriades D. Nonoperative management of
splenic injuries; have we gone too far ? Arch Surg. 2000; 135:
674-681.
10. Cocanour CS, Moore FA, Ware DN, Marvin RG, Clark M, Duke
JH. Delayed complications of nonoperative management of
blunt adult splenic trauma. Arch Surg. 1998;133: 619-625.