Notes

Hernia

Hernia Etiology Inguinal Indirect Most common Congenital patent processus vaginalis LATERAL to inferior epigastric vessels Through both internal and external inguinal rings Direct Breakdown of fascia transversalis MEDIAL to inferior epigastric vessels Through floor of Hasselbach triangle Medial → Rectus sheath Superolateral → Inferior epigastric vessels Inferior → Inguinal ligament Femoral Women > Men Weakened...

Obstructive Jaundice

Choleducolithiasis Pancreatic cancer Colangiocarcinoma Ampula of Vater cancer

Pancreas Surgery

Colorectal Surgery

Esophagus Surgery

Hiatal Hernia Sliding Gastroesophageal junction + part of stomach displaced above diaphragm Medical + Lifestyle change → ↓GERD Paraesophageal Gastroesophageal junction in place Stomach fundus displaced above diaphragm Gastropexy → Prevent gastric vulvulus Esophageal Cancer SCC Most common worldwide Upper/Middle third Alcohol Tobacco Nitrosamines Adenocarcinoma Most common in US Lower...

Abdominal Pain

Abdominal Pain Referred Pain MI → Left chest, Jaw, Left arm Gallbladder → Right shoulder, Scapula Pancreas → Back Pharynx → Ears Prostate → Tip of penis, Perineum Appendix → RLQ Esophagus → Substernal Pyelonephritis → CVA Nephrolithiasis → CVA, Perineum Cold food → Brain freeze Rapid temp change...

Leg Ulcers

Postop Complications

Postop Chest Pain Postop Confusion Etiology Hypoxia PE Atelectasis Pneumonia Sepsis Presentation Confusion!! Diagnosis ABG CXR Blood culture Urine culture CBC Treatment ARDS Presentation Sever hypoxia Tachypnea Accessory ventilatory muscle use Hypercapnia No JVD Diagnosis CXR → Bilateral infiltrate No JVD → Rule out CHF...

Virilization

CAH → ⬆︎Urinary 17-OH Progesterone

Infertility

Ovarian reserve → Early follicular FSH ± Estradiol Order for workup Penis Sildenafil Counseling Semen ICSI Mucus Estrogen Artificial Insemination Ovulation Clomiphene Pergonal (Menotropin, hMG) Anatomy ICSI IVF Tuboplasty Surrogate Endometriosis Laser ablation Idiopathic Adoption

Secondary Amenorrhea

Secondary Amenorrhea Definition → No menses for 6 months Etiology Pregnancy Breastfeeding Anovulation PCOS Pituitary adenoma ↑Prolactin ↑TRH PRIMARY hypothyroidism SECONDARY hyperthyroidism Hyperthyroidism Medications Antidepressants OCP Estrogen deficiency Ovarian failure Menopause Premature ovarian failure Hypothalamic pituitary insufficiency Outflow obstruction/stenosis Asherman’s syndrome Stress Extreme weight loss Excessive exercise

Puberty

Precocious Puberty Types Central → GnRH dependent Peripheral → GnRH independent Diagnosis Wrist X-ray → Bone age GnRH stimulation test Give leuprolide (GnRH agonist) ↑ LH → Central No change in LH → Peripheral