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Types of incision
Kocher-cholecystectomy
Chevron-gastrectomy bilateral subcostal
Mcburneys- appendectomy
Pfannensteil-OB
Fowler weir- medial extension of rocky Davis
Roterford morisson- lateral extension of rocky
Davis
Lanz incision- following the skin crease for
appendectomy
Cattel-is right release of peritoneal reflection
Mattox- left mobilization of descending colon
Kochers maneuver- mobilization of transverse
colon
Staples- Least reactive on skin (BUT NOT ON
FACE)
Pringles maneuver- hepatic pedicle (25%-
hepatic artery, 75%-portal vein, common bile
duct)
Cantle’s line- separates the right and left lobe
of liver
Thyroid cancer
Most common-Papillary Thyroid Cancer in
iodine rich area-80%
Follicular-Iodine Deficient Area
TRAUMA
patients under 11 crycothyroidectomy is
contraindicated for the risk of subglottilc
stenosis tracheostomy should be performed
CTT-Posterosuperior on 4th and 5th rib
First 12 hours-pulmonary contusion
progression
Types of injury tracheobronchcial
Type I- 2cms from the carina
Type II-more distal to tracheobronchial tree
bronchoscopy to confirm diagnosis
Systolic BP
60mmHg-Carotid
70mmHg-Femoral
80mmHG-Radial
Abdomen
DPL->250ml to have positive results
>10ml-positive
<10ml-do 1L PNSS Infusion and Syphoning
then send for cell cytology
For children less than 6years old-a transverse
incision is more advantageous
hepatic abscess
<1cms multiple- sampled and treated 4-6weeks
course of antibiotics
large abscess- incision and drainage
abdominal wall
-congenital umbilical hernia closes
spontaneously by 5years old.
-Omphalocele protudes through an open
abdominal ring with sac
-Gastroschisis protudes lateral to the umbilical
ring without a sac
-Rectus diastasis is associated with abdominal
wall bulging consequent to separation of the
rectus abdominis muscles in the midline.
-Fothergill’s sign is a palpable abdominal mass
that remains unchanged with contraction of the
rectus muscles and is classically associated
with rectus hematoma
-for laparoscopic mesh repair- atleast 4cms
overlap of mesh in an healthy abdominal wall.
-idiopathic retroperitoneal fibrosis, also known
as Ormond’s disease 90-100% 5year survival
rate
-fourth to the sixth decades of life.
-Corticosteroids, with or without surgery, are
the mainstay of medical therapy. Surgical
treatment consists primarily of ureterolysis or
ureteral stenting and is required in patients who
present with significant hydronephrosis.
Appendix
-Carcinoid,
Treatment for tumors ≤1 cm is appendecto
my. For tumors larger than 1 to 2 cm located at
the base, involving the mesentery, or with
lymph node metastases, right hemicolectomy is
indicated.
-Adenocarcinoma, recommended treatment is
formal right hemicolectomy
-Stump appendicitis, >0.5cms stump
-2nd Trimester is safe for appendectomy and
rare on 3rd trimester
Esophagus Chapter 25
-aortic arch is T4
-lower sphincter is T11
-male 15cms/female 14cms
blood supply
upper 3rd-inferior thyroid artery
thoracic portion-bronchial arteries
abdominal portion-ascending branch of left
gastric and inferior phrenic arteries
swallowing mechanism
1 elevation of tongue
2 posterior movement of tongue
3 elevation of soft palate
4 elevation of hyoid
5 elevation of larynx
6 tilting of epiglottis
chapter 26 stomach
left gastric artery- largest artery
right gastroepiploic artery-second largest
D1 Gastrectomy- station 3 to 6
D2 Gastrectomy- station 1-2 and 7-12
Chief cells (zymogenic cells)- pepsinogen I-
fundus and body
Parietal Cells- HCL-body of stomach/fundus
G cells/Oxyntic cells-Gastrin (antral)
D cells-Stomatostatin-antral
Ghrelin-Anorexia and weight loss
12mins- Half emptying time of liquid
2hours-half emptying time of solid
SIRS
Infection-identifiable source of microbial insult
SIRS-two or more are met:
-Temp >38 or less than 36c
-HR of more than 90BPM
-RR of more than 20CPM of <32mmHg
-WBC of more than 12,000 or less than 4000
and Bands more than 10%
Sepsis-Identifiable source of infection +SIRS
Severe Sepsis- Sepsis +Organ Dysfunction
Septic Shock- Sepsis +Cardiovascular Collapse
(requiring vasopressors)
Adrenocorticotrophic Hormone-Zona Fasculata
Cortisol-Adrenal cortex, in burn patients
elevated for 4weeks