Surgery Notes
This page is dedicated to discussion on topics relevant to the field of Surgery. Join if ur a medico!
04/05/2024
For those interested in discussing oncology cases, I have created a telegram channel named open tumour board. Joining is free for first 100 members of Surgery Notes page!
Click the link below to join and discuss challenging cases in oncology!
15/04/2024
Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. However, bowel intussusception in adults is considered a rare condition, accounting for 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Secondary intussusception is caused by organic lesions, such as inflammatory bowel disease, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms or even iatrogenically, due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery.
This patient came with features of bowel obstruction . When we opened up the abdomen, a long segment jejunoileal intussusception was discovered . The second pic shows a polyp as lead point that was found to be a benign on HPE.
10/01/2024
A journey of 1000 miles begins with a single step.
Thank you, each one of you!
07/09/2023
BCC tumours are a type of skin cancer that arise from the basal cells of the epidermis. They are usually slow-growing and rarely spread to other parts of the body, but they can cause local tissue damage and disfigurement if left untreated. The main risk factors for developing BCC tumours are exposure to ultraviolet radiation, fair skin, genetic predisposition, and immunosuppression.
The management of BCC tumours depends on their type, size, location, number, and patient factors. The most common treatment is surgical excision, which involves removing the tumour with a margin of normal skin around it. The pathologist will examine the tissue to confirm the diagnosis and check if the margins are clear. Other treatments include cryotherapy, curettage and electrodessication, topical creams, radiotherapy, photodynamic therapy, and oral medications.
The prognosis of BCC tumours is generally good, as most of them can be cured with appropriate treatment. However, some BCC tumours may be more aggressive or recur after treatment, especially if they are located in high-risk areas such as the nose, ears, eyelids, or lips. Therefore, long-term follow-up and regular skin checks are recommended to detect any new or recurrent lesions.
Summary generated using BingAI
What are the differentials and how do you proceed?
06/09/2023
https://youtube.com/shorts/k15S-iajQ3Q?si=KA9usjYpATlEZ28Q
Can u diagnose the condition. What should be done next for managing this patient? #Surgery #clinical
27/08/2023
Lets talk about Endometrial Carcinoma
Endometrial carcinoma (EC) is the most common gynecologic malignancy, accounting for about 3.6% of all cancers in women¹. EC can be classified into two types based on histopathology and molecular features: type 1 and type 2. Type 1 ECs are usually low-grade, estrogen-dependent, and have a favorable prognosis. Type 2 ECs are high-grade, estrogen-independent, and have a poor prognosis².
Surgery is the mainstay of treatment for EC, regardless of the type. However, the extent of surgery may vary depending on the stage and risk factors of the disease. The standard surgical procedure for EC is total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO), which involves the removal of the uterus, cervix, fallopian tubes, and ovaries. In addition, pelvic and para-aortic lymph node dissection (LND) or sampling may be performed to assess the lymphatic spread of the cancer and guide adjuvant therapy³.
For type 2 EC, which is more aggressive and prone to metastasis, surgery alone may not be sufficient to achieve optimal outcomes. Therefore, adjuvant therapy, such as radiation therapy, chemotherapy, or hormone therapy, may be recommended after surgery to reduce the risk of recurrence and improve survival⁴. The choice of adjuvant therapy depends on several factors, such as the stage, grade, histologic subtype, lymph node status, and molecular profile of the tumor⁵.
The role of radical hysterectomy (RH), which involves the removal of the parametrium and upper va**na along with the uterus and cervix, in type 2 EC is controversial. Some studies have suggested that RH may provide better local control and survival than TAH in patients with cervical or parametrial involvement⁶. However, other studies have found no significant difference between RH and TAH in terms of oncologic outcomes or morbidity⁷. Therefore, RH is not routinely recommended for type 2 EC unless there is evidence of extensive cervical or parametrial invasion.
Post generated using Bing AI .
Anatomy class on branches of Aorta.
29/07/2023
This anatomy is the most important when dealing with Upper GI malignancies. If you can memorize it and apply this clinical knowledge while operating I guess the outcome is bound to be good.
Screenshot this image for reference.
Do u know which vessels are ligated and which are remaining arteries when making a stomach tube after esophagectomy?
The ribs are an essential component of the human body, forming the majority of the thoracic cage. They are curved, flat bones that are light but highly resilient, contributing to their role in protecting the internal thoracic organs.
One of the primary functions of the ribs is to protect the lungs and heart from physical damage. The rib cage surrounds these vital organs, providing a barrier against external trauma.
In addition to providing protection, the ribs also play a crucial role in facilitating breathing. The movements of the ribs, controlled by the diaphragm and intercostal muscles, allow for the expansion and contraction of the thoracic cavity. This movement enables the lungs to inhale and exhale air, allowing for respiration to occur.
The ribs also provide a place for some muscles to originate or attach. These muscles play a role in various bodily movements, including those involved in respiration.
In summary, the ribs serve several essential functions in the human body, including protecting vital organs, facilitating breathing, and providing a place for muscle attachment. These functions highlight the importance of maintaining healthy ribs and rib cage.
An interesting video on a rare tumour of Head and neck region.
I tried to create this video using four platforms/apps- Chatgpt, text to audio app , inshort (video editing) and kapwing (for subtitles).
Let me know how the result is.
28/06/2023
Every step in surgery is important. A single mistake can have serious consequences for the patient. Surgeons must take great care to ensure that every step of the procedure is performed correctly and safely.
The first step in surgery is to prepare the patient for the procedure. This includes ensuring that the patient is properly anesthetized and that all necessary equipment is available and in working order.
The next step is to make an incision in the appropriate location. The incision should be made carefully to avoid damaging any surrounding tissue.
Once the incision has been made, the surgeon will begin the procedure itself. This may involve removing tissue, repairing damaged organs or structures, or performing other necessary tasks
20/06/2023
Floor of Mouth tumour
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This pt. presented with a mass lesion in oral cavity . On examination he was found to have Carcinoma at Floor of mouth.
The floor of mouth is bounded anteriorly and laterally by the lower gingiva , medially by the oral tongue, and posteriorly at the insertion of the anterior tonsillar pillar into the oral tongue. The mylohyoid, genioglossus, and geniohyoid muscles comprise the muscular floor of the oral cavity. This region is divided into right and left halves by the lingual frenulum and contains the ostia of the submandibular and sublingual salivary glands.
Treatment options for tumours at this location includes:
Primary resection and reconstruction, ± neck dissection
Adjuvant postsurgical radiation ± chemotherapy (for high-risk histologic features, + surgical margins)
18/06/2023
This patient presented to us with Pain in Rt lumbar region along with intermittent hematuria.
Renal cell carcinoma is a tumor with the distinct feature that it can invade through the renal vein into the inferior vena cava, and can grow intravascularly, sometimes extending into right cardiac chambers. In this patient the tumour thrombus is extending till infrahepatuc IVC.
Historically, chemo- or radiotherapy protocols had been deemed ineffective in attaining complete control the tumor burden of advanced RCC. Resection provides the only reasonable chance for a cure .
In case of level II thrombi, it is crucial to obtain adequate exposure and control of the infrahepatic and retrohepatic IVC before cavotomy and thrombectomy . This can be achieved through mobilization of the posterior surface of the liver. Some small hepatic and lumbar veins should then be ligated and divided. Vascular clamps can then be placed on the contralateral renal vein and IVC below and above the thrombus. Then, a cavotomy and thrombectomy can be performed. Clamping below the hepatic venous confluence obviates the need for bypass due to collateral venous return via the lumbar, azygos-hemiazygos, and portal venous system .
14/06/2023
11/06/2023
During my ward rounds I came accross this ECG which looked like an Ideal ECG pattern. I am not a "Cardiologist" but I think Surgeons should know basics of ECG . We are encountering a lot of cardiac issues in our patients these days.
I would like to encourage the followers to send me the ECG pictures which they find interesting during their routine patient encounter. I will be happy to share it on the platform with due credits! 🙂
A normal electrocardiogram (ECG or EKG) pattern consists of a series of waves and intervals that represent the electrical activity of the heart during a heartbeat. The waves and intervals in a normal ECG pattern include:
1. P wave: A small upward wave that represents the electrical activity of the atria (the upper chambers of the heart)
2. QRS complex: A larger complex that represents the electrical activity of the ventricles (the lower chambers of the heart)
3. T wave: A small upward wave that represents the electrical recovery of the ventricles
4. PR interval: The duration between the onset of the P wave and the onset of the QRS complex
5. QT interval: The duration between the onset of the QRS complex and the end of the T wave
In a normal ECG pattern, the P wave, QRS complex, and T wave should all be present and have a consistent shape and duration. The PR interval and QT interval should also fall within normal ranges.
(This message has been generated by Nova AI)
The submandibular gland is one of the major salivary glands located in the submandibular triangle of the neck, just below the lower jawbone (mandible) and deep to the sublingual gland. It is a large, encapsulated gland that produces about 70% of the total saliva volume in the oral cavity.
The submandibular gland is roughly triangular in shape and weighs around 15 grams. It is composed of two main parts: a superficial part and a deep part. The superficial part lies anterior to the deep part and is separated from it by the mylohyoid muscle. The deep part is located posterior to the mylohyoid muscle and extends medially towards the midline.
The gland is surrounded by a fibrous capsule that sends septa into the gland to divide it into lobules. Each lobule is composed of a cluster of acinar cells that produce saliva and a network of ducts that transport the saliva to the main ducts.
The main duct of the submandibular gland, also known as Wharton's duct, is about 5 cm long and runs anteriorly along the floor of the mouth. It enters the oral cavity at the sublingual caruncle, a small papilla located on the floor of the mouth near the midline. The duct is lined by a stratified columnar epithelium and is surrounded by a layer of smooth muscle that contracts to help propel the saliva into the oral cavity.
The submandibular gland receives its blood supply from the facial artery and its venous drainage is through the facial vein. Its innervation is supplied by the facial nerve (parasympathetic) and the sympathetic nervous system. The parasympathetic fibers stimulate the secretion of saliva, while the sympathetic fibers regulate blood flow to the gland.
Text generated via Ask AI app.
23/05/2023
Locally advanced gallbladder cancer is a challenging disease to manage, and surgical management may be limited by the extent of tumor involvement of vital structures in the vicinity of the gallbladder. The surgical options for locally advanced gallbladder cancer depend on the extent of the disease and the patient's overall health status.
If the cancer has not spread outside the gallbladder but has invaded the liver or adjacent organs, surgery may involve removal of the gallbladder, part of the liver, and other organs affected by the tumor. This surgery is called an extended cholecystectomy and is considered the standard of care for locally advanced gallbladder cancer.
However, if the cancer has spread beyond the gallbladder and involves nearby lymph nodes or distant organs, surgery may not be curative, and other treatment options, such as chemotherapy and radiation therapy, may be considered.
It is important to note that the management of locally advanced gallbladder cancer requires a multidisciplinary approach involving a team of surgical, medical, and radiation oncologists, as well as pathologists and radiologists, to ensure the best possible outcome for the patient.
In a normal healthy person, the jugular venous pulse (JVP) waveform comprises of three positive waves and two negative troughs:
1. A wave: This is the first positive deflection and represents the increase in pressure that occurs during atrial contraction. It lasts around 0.08-0.12 seconds and has an amplitude of 3-4 cm H2O.
2. X descent: This is the first negative trough and represents the atrial relaxation and downward displacement during ventricular contraction. It occurs immediately after the A wave and lasts around 0.1-0.2 seconds.
3. V wave: This is the second positive deflection and represents filling of the atrium during systole. It is larger in amplitude and has longer duration than A wave, it may last for 0.2-0.4 seconds.
4. Y descent: This is the second negative trough and represents the emptying of the atrium in diastole, as the tricuspid valve opens. It lasts around 0.04-0.08 seconds.
5. Z point : Most physician's do not include Z point as a distinguishable wave. It is the point where the Y descent and next A wave merge together.
A healthy JVP waveform has a dominant atrial contraction (A) wave that occurs just before carotid pulse, followed by a drop in pressure as the atrium relaxes (X descent) and the filling of blood into the right atrium (V wave).
The y descent subsequently occurs because of the opening of tricuspid valve and emptying of right atrium into right ventricle.
The visualization of the normal JVP waveform is essential for identifying any cardiac abnormalities indicating that the heart is functioning correctly.
Credits: This text has been generated by Nova - My AI assistant
AI generated note on Retrosternal Thyroid:
(Though the information is precise however It's still lacking somewhere . What do you think?)
Retrosternal thyroid refers to a condition where the thyroid gland is enlarged and located inside the chest, rather than its normal position in the neck. The diagnosis of retrosternal thyroid is confirmed through imaging studies such as CT scans or MRI, as well as by physical examination.
Examination for retrosternal thyroid involves a thorough evaluation of the neck and chest area, and may include palpation of the thyroid gland, listening for airflow through the trachea, and assessment of any symptoms such as shortness of breath or difficulty swallowing.
Treatment for retrosternal thyroid depends on the severity of the condition and the associated symptoms. In some cases, close monitoring of the thyroid gland may be sufficient, while in other cases, surgical removal of the thyroid may be necessary to relieve pressure on surrounding structures.
Complications from retrosternal thyroid can sometimes be serious, such as compression of the airways or blood vessels leading to the brain, therefore early diagnosis and treatment are critical.
It is important for individuals experiencing symptoms related to the thyroid gland to seek medical attention promptly, as early intervention and treatment can prevent potential complications and ensure a successful outcome.
This message has been generated using AI software Nova.
17/04/2023
This patient has come to us with a large bony swelling .
• Adamantinomas are locally aggressive tumor and are extremely slow growing with the potential to metastasize.
• The initial symptoms of adamantinoma are often indolent and nonspecific and depend on location and extent of the disease. The onset is insidious and its course shows a slow, progressive character. The patient often tolerates symptoms for many years before seeking medical attention.
• Current treatment of adamantinoma, including en bloc tumor resection with wide operative margins
05/04/2023
Work in progress!
02/04/2023
Endometrial Carcinoma.
Draft page!
https://fb.watch/jF3Ym9DV8N/
Rounds !
Gallbladder cancer patients are often asymptomatic at presentation or describe vague symptoms such as abdominal pain, nausea or vomiting, indigestion, weakness, anorexia, loss of appetite, weight loss, and can present with jaundice, which can easily be confused as cholecystitis. Biliary obstruction by cancer leads to jaundice, clay-colored stools, cola-colored urine, and skin pruritus.
The prognosis of gallbladder cancer is poor due to the aggressive tumor biology, late presentation, complicated anatomic position, and advanced stage at diagnosis. Locally advanced and metastatic disease is treated with palliative chemotherapy. Conversely, early stage is potentially curative with surgical resection followed by adjuvant therapy.
31/03/2023
SEMS
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More than 50% of esophageal cancer patients are diagnosed at an advanced stage when the esophagus has often been occluded by the tumor. To open the occluded esophagus, a self-expanding esophageal stent is often used for drinking and feeding, which has become the primary palliative therapy of dysphagia.Tumor ingrowth or overgrowth is one of the most delayed complication.
31/03/2023
Parathyroid preservation during thyroidectomy
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One of the most common reasons why surgeons object to prophylactic CND is the risk that patients will develop postoperative hypoparathyroidism. According to literature reports, the incidence of transient and permanent hypoparathyroidism after thyroidectomy is 1–50% and 2.5%, respectively. Patients with transient hypoparathyroidism should take calcium and vitamin D supplements during the recovery period; most will eventually recover parathyroid function
30/03/2023
How many Arteries can you identify in this CT angio.
Can you identify the pathology in this pt.
Clinical:
Female with Rt Abdominal lump.
Videos (show all)
