Surgery

Gallbladder Surgery

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...

Peripheral Vascular Disease

Etiology DM Hyperlipidemia Hypertension Smoking Presentation Leg pain (calves) on exertion → Intermittent claudication Both walking UP and DOWN hill Spinal stenosis is worse walking DOWN hill Smooth shiny skin Loss of Hair follicle Sweat gland Sebaceous gland Diagnosis Best initial → Ankle-brachial index (ABI) → <0.9 Most...

Orthopedics

Hand Fractures Presentation Pain Swelling Deformity Diagnosis → X-ray Treatment rules Closed reduction Mild fracture No displacement Open reduction + internal fixation Severe fracture Displacement or misalignment Surgery and debridement Open fracture Types Comminuted fracture Bone broken into multiple pieces Cause → Crush injuries Stress fracture Cause → Repetitive insult to bone...

Acute Abdomen

RLQ Pain Appendicitis Etiology Lymphoid hypertrophy Fecalith Foreign body Tumor Parasite Presentation M > F 10-30y Periumbilical pain 1-12h THEN → RLQ pain → MacBurny point N/V Anorexia Fever ↑WBC with left shift RLQ tenderness Signs Rovsing sign → LLQ palpation causes RLQ pain Psoas sign → Pain with hip...