General Surgery Rohan Marrow 4 Imp
General Surgery Rohan Marrow 4 Imp
General Surgery Rohan Marrow 4 Imp
Dr ROHAN KHANDELWAL
WHO Checklist
I
M.c cause of Missmatched Blood transfusion
J
signing ITImeautJ
I
outy
Isign
SOTT
Iward Before skin incision Attime of
Skinclosure
confirm identity
consent written
surgeon lN4mJ
I
count gauzyEquipment
IsitemarkingJ surgery
Anticipated surgeon
Allergies
Bloodloss Actual surgery
serology
viralmarkers Anesthetist Any concern
I Anesthetist
Anyconcern
prophylacticAby Actual Blood loss
protective zone Cleazzone
change Rooms 7 connect protective zone
Asepticzone L
y Disposal zone
OT waste
t L
Thickest thinnest
Maxflowrate Least flow rate
commerisal procedure
I supine E Abdominal s Breast
Thyroid
2 Lithotomy
Gyrelobs Haemonoids cystoscopy TURP
MC Ingyred in the Lithotomy positions
commenpermealNernec3
for Lateral kidney and thoracotomy
I
in this Sx overabduction can causes Brachial plexus
of arm
injury
gasused coz
GAS Beneath dome
of diaphragm
I
irritated
I
shoulder tip pain
surgicalBlade
OO
Energy source
I
for aThyroid
parathyroid
Egrlobule
penile
safe in pacemakers pins
suture and surgical knot 3
insecureknot Slipknot
surgeon's knot
subcuticularsuturing
1
3 O monocryl suture
if the depth
do
143rd
g
Kody
SUTURE
L J
Natural synth moreinert
1 most inert
More Infection Is Synthetic Non Absorbable
S4t
Monofilament Multifilament
IABSORBAB.LI INM
ABSORBABLEJ
Natural synthetic
t
I IMONOCRH.fi
Non Absorbable
Natural synthetic
silk Cpzoline
Skin Hernia mesh
2ndLayer ofBOWEL vascular Repair
Fix drains Close the Recture sheath
4times length of wound
EthimJ
NY1m
Skin
uses
Tendon
Nerve fix drain
Sutenefemoval
Neck 5 7 days
Thorax 10 12days
Abdomen 12 14
days
Perinium 12 14
2 Sleeve gastrectomy
causes of Post Op feverg
t
Post day 1 MC C Atelectasis
t
incentive spirometer
chest physiotherapy
supthrombophlebitis
Post op Day 05 Me cause of HAI
in a surgical patient
Surgicalsify
1
any wound infection within days of surgery B
if an implant 2 year
Mx emergency Mx
I
UROBAG LAPROSTOMY
unbag lapostony I
definativeRx thesuture
of
Rectus sheath
suture f prolineused
m
i t
Ambulatory
overran supine
He
I µ
pelvis or Morison's fffyweisordouglasJq
pouch ofdoughs pouch
Ioc CECT 0
drain wig
pigtail
catheter
Types of wound
CABG
Lscs
Hysterectomy
IT contaminated 8
GIIGUsystem when Non purulent 10 2040
inflammation is
Bowel prepared
Ans
thumb
prophylactic Abx
I
Best time 30 Min 1 Hour before surgery
In
Abdominal Surgery
to
I
Nipples to mid Kuframammary fold to
thigh midthigh
Cleanfrom Lateral to medial
Adequate Haemosiasia
0 inhalation in the immediate post op period It
SURGICAL NUTRITION 8
T
Entree Parentral
GUT Itv
1
Best route
1
oral Route
1
if not possible
I
s3w
C 3weeks µ
I feedinggastrostomy feeding Jgyrostomy
we use it
NGTube morephysiological
Ryle'sTube but HigherRateof
Aspiration
How to measure
Lenghth
Tip ofNose to Eatlobule
I
xiphisternum
Bestposition sitting
NeckSlightly Flexed
How to checkposition
gastricAspirate
otherwisepush air and
Auscultate in epigastrium
Complication of entral Nutrition 8
Tube Related Mrcfeeding Regime complicating
14 I
M C Overall Osmoticdiarrhea
PARAENTRAL
TRITIONII.ru
Routes
complication of Tpm 8
Iii
mn
PR 901min
Any 2 parameters SIRI
SIRS t known foci Sep
of infection
sepsis Wich causes Hypotension Septfc8h
failure of 2 or more organ system M
1
Multiple organ dysfunctional syndrome
O
Hypovolemic Shock
www mu
pp A Ap
SBP Normal
DBP
Fput Normal I
NM
RR Normal 9 Recordable
BASE
Deficit
2 to 6 Gto 10 v
A peripheral
co ShuntBlood C Vasoconstriction
to Extra vital cold
SBP
organs PPUR T DBP
compensated
v if we transfuse
10 Units 24HRS 447175in entheBlood volume in
one HR 44HRS
complication 5 Hypothermia
enter by diuretics
prev CHISIX
TRALI Transfusion Associates Acute14mg Ryung
HLA
ARDS
Q
Bestindicator to determine Amount of Fluid Required in Shock
Pcwp pulmonary capillary wedge pressure Cup central venous
patients
Best indicator
of Fluid Resusitation in shock
Urineoutput
shock index
I j Rope
modifiedshock Rateover pressure
differentite
different
3p
HR
Mostsensative
Hyperdynamic
Bradycardia Circulation
Hypovol Cardiogenic Neurogenic Anaphylactic septic
shock f l
2 Hypotension warm cod
PR R Rfd L T A
SBp I d t T
f
co L d L L T
VR T T t I I
Jrp j T I I
I
warm Ct PVR
11
Pooling of Blood 1 VenousReturn
He
1 Jvp Ico Is Bp
Anaphylactic
TRAUMA
Trimodal distribution of mortality
MassiveHead ingysy
Atimpact Aortictransecting
mortality
IEighoisintmainminny's
Pneumothorax
I
Jing Tensing
ia
a
im n
eariEeam
Time
within
if proper intervention done in IHR then mortality can be
prevented So 1 HOUR is Trauma is Golden HOUR
Isurvey 20survey
t 1
Detailed survey in Wich all other
ABCD 1 Life instries are searched
thretening injury
LOGROLL
11
Examine Back of a trauma PEN
Min No of people
Airway
Cervicalspi Followed by Airway
t
a Dangersign of
Pf cervical spine Kyung is airwaycompsomice
Suspected
I I
we immobilized c spine 1 Unable to speak
Using a HARD PHILADELPHIA COLLAR21 2 Gc
do Imaging
3 comatose
Tt
securethe airway using
Orotracheal intubation
t it ta
y Is
emergency M DefinitiveMx
Needle Tracheostomy
Crieothyroidotomy
circulation
I A
lines Em 188
Insert 2 LargeBone Ifr
v
L y
Emergency intervention
Definative
a
centralline
Intraosseous venous cutdown Mc lI
infusion
a
Just below
Tibialtuberosity greatsaphanay
vein
intubated
O
O
8
t He
Eg
Non testable
EzVNTM3
5
min Gcs 03
Max 15
mild Head Kyung 13 15
Mod i 09 15
severe i Ii 8
O
ABDOMINAL TRAUMA f
Mfc organInvolved
overall spleen
Blunt spleen
penetrating liver spleen
GSW Cgunshotwound SI
Seat Beatt Sx Mesentery
L
Hemodyanmically Unstable
Stable
First FAST FAST
I OC CEI FAST If FAST
I
LAPAROTOMY
HOWFAST 3 5min midline
RtHQ
Minimum fluid detected on FAST Examination
penetrating
s ft perftBreach
if supto peritoneum peritonitis
Localexploration
FIB omentum is Hanging out
suturing Baestaining of Dressing
FIB I
C Do I LAPAROTOMY
splenictrauma
Isuspect
kH 2ign
if
splenic Rupture
I 9 11 Ribs on Leftside
if we Raise LL
Blood Acc Beneath
dome of diaphragm
I
left shouldertip pain
Grades
Laceration I cm in deapth
Ioc vative Mx
conser
usually
stable CECT Monitor vitales
A serial 24 HR CECT
I t it grade of Kyung TT
ANGIOEYMBOLIZATION
u I
Ha
Unstable
f Usually Unstable
I O c FAST
surgtesy splenoRRAPHY
1 surgery
splenectomy
complication ofsplenectomyor
J 20Hemorrhage Fewdays
infection
pancreatic fistula
Hematological change
L J
transient permanent
A WBC HOWEL JOLLY BODY
2W
BASOPHILIC STIPPLING
IfPRBf a RETICULOCYTES
HYPERSEGMENTED WBds
M C organism ENCAPSULATED
pneumococcus
H9ufMM2a
meningococcus
children Adults
Occurs in 1st After surgery
High mortality
Hematological condition 7 Trauma
prevents
t
vaccines
Eiece Emergency
Besttimef Hr
Hr P0
2 weeksbefore
HA CBD
Bleedingsstopsthey
PV continious dueto
or Hepaticvein
Mesentric trauma Mc seatbelts
MY MY
Rx
In No Loss of vascularity Repair Anastomosis
Rx Repair tear
Hypothermia Acidosis
phase phase
PHASE0 Pt M
identification E Laparotomy I Reexploration
t I cU
of P T Aim I 1
StopBleeding Aim Aim
L ER t I
prevent contamination correct correct
physiology Anatomy
thoracic Trauma Rib simplest form
of thoracic
trauma
Mtx
Adequate Analgesia
is
strapping Gtd
if if
1StRib Occurs Lo 12thRib
Uncommon Gloating Rib
1 subclavian
canbe
damage
II g Spleen Liver
Mc c of mortality in thoracictrauma
6 4
Blunt penetrating
More places
problems
I
paradoxicalchestwall movements
I
ft's leads to pulmonary contusion
M c cause of Death
ME Adequate analgesia Oa
Ivdespite
Ff RR 20 Min
POI 60MmHg
1
IPPV
Tension pneumothorax 8
gf D
I in
TAMPONADE
t
tension pneumothorax cardiac Tempondae
Clinically Hyperresonant percussion
Note
Absent Breathsound MuffledHeartSound
Investigation EFast EFast
L J
emergency Definative
Needlethoracocentesis d
Tube thoracocentesis
I b t
children Adults
incertion Ict intercostal tube
of
2nd 5th I c s in D of Safley
Mfcspace
midclavicularline midAxillaryline
and we cover sucking wound with
gauze and tape it on 3 side
Tx Haemothorax B
I
Accumulation
of Blood in
pleuralspace
source Intercostal Vesseles
Tamponade
esophageal Kyung
ICT Dt tube 5
of safety
in
EfX
Movement of water column indicate A Functioning
Tube
d T JVP
Rapid Accumulation Blood in Muffled Heartsound
of
the pericardial space
FASTIEFASI
M
Emergency
I
Needle penocardiocentesis
insert a needle viasubxipodSpace
Under EcholUs guidence
Definative
emergency thoracotomy and Repair tear
NeckTrauma 3
1
traumazone
to Base
zone 03 angle of mandible of Skull
Head trauma
I tissue
Fibrous
septate
scalp laceration
Bleed profusly
t
Wales
of vessels
o
que
wa ca
cut
suture
curlingulcers stress ulcer Dz
Ioc M L
H Burns
Mx3 Raised ICT
sign punctate Hemorrhage
l Adequate 02 I Vfluids
At grey's a white matterjynetiq
Avoid dextrose containing fluids
worst prognosis
3 I v mannitol
3 BrainHemorrhage 8
contusion Intraparenchymal M C traumatic
D by Nat
SAH subarachnoid
Mx conservative
EbHCExt d
Traumais m.ccauseofs.AM
Tµ
Extractural s
t
seen in young Pat's Highlevel impact
Arterial Middlemeningeal
Lucid intervel
ye
N consciousness b w 2 episodeof Unconsioousness
Ioc NCCT
Mx Bursts Made on side of iyysy
Mic site ptenon temporal Region
t
H shaped Area in T R
so if Nat is unavalible then BurrHole on side of pupillary
dilatation
subdural Hamessohage
I
due to Bridgingvein
usually in elderlyPINS
after Trival trauma
Altered SensoriumAfterfewdays
Bleeding bw Dura and arachnoid
Mx Burrte
TX Byers ABCD
t Exposure Amountof Burns
severity of Burns
parkland's Formula
94
X BW X TBSA
Burnt
Amount of Fluid in in in the 1st
Kgs 24HRS
In
1stdegreeBurns are Next
Excluded
YzAmount 1 2 Amount
Eg 60kg man
lot 1st degreeBurn 4 60 20
toy 2nd a
2
60kg man
zoy 2nddegreeBurn 4 60 20
4pm 6pm a
Amount of fluid till midnight
3 Dextrose containing maintanence fluid given to children in
Addition to parkland
Targeturineoutput
New ATLS formula
Adults 2X BWX TBSA 0.5mi 1kg1 HR
TBSA Burn 8
PALM 1
WALANCE RULE OF 9
t
perinium 2.1
Best method for 4 total BSA of Burn
LUND and BROWDER CHARTS
Degrees of Burns
2nd degree
L J
sup deep
I
Epidermis papillary dermis Epidermis Dermis
Red Tender Blanching Red lesstender some area
dn't Branch
Blisterformation less Blisterformation
Heals in 2 3 Weeks c out 41
scarring but Requirespecial material Tendency to form Hypertrophic
scar and keloids
Special materials
special situation
17 chemical Burns
Alkali Burns severe
Never
try Nutrilizatim
wash with water
2 Electrical Bums
m c c of death Anythemia
AfcBurns
I
induced
Tetany
I
Myoglobinuria
E Burns are Highgrade Burns always LOOK
for entry and
Exit
3 Lightening injury
L J
Indirect
Direct
Highgradeelectricalinjury Lightening strikes and object
and sparks fly off
1
Superficial Burns on ExposedArea
I
FILIGRI BURNSo
plastic surgery e
C Autograft sameperson
2 Iso Identicaltwins
graft
3 Allograft samespecies
147 Xenograft Different is
graft
Does not Have own Bsupply
Split thickness skin Fullthickness
StsG graft CFTSG
Thin Thick
THIERSCH o WOLFE's
I DONOR
Mrc Donor site
Thigh post Auricular skin
supraclavicular fossa
11
Kufra in
INIVERAXILLATE
infection
postburn
contractures
Rhomboid Limberg
forpilonidalSinusSx
Jeepdriver'sdiseases
Rotated Named blood vessels
Axial flap9 they are
we use Latssimus
Dorsimuscle
flap for Breast
Reconstruction
M.c Used
flap for Breast Reconstruction 8 TramTransverse Rectus
cutaneous
Abdominusmyo
flays
Best flap DIEP 3 Deep inferior epigastric A perforatorflap
prevention
water airbed
VAC
ve pressure dressing 125MmHg
1
YES Chronic non Healing wound
Venous ulcer without Slough
Diabetic ulcer without osteomyelitis
I
if wound is infected leave it open when granulation
tissue
I
suture after
Hypertrophic scar keloid
IntraKismat Tnhmcinolone
Mx
J is 20 lactiferousgland
involved
a
Retraction
Pmajor
of
Nipple
LigamentofCooper
involved
Dimplicering
Peau d
orange
t
O
due to subdermal blockage
of Lymphatics
Lymphaticdrinage
e
n
Axillary L N 90 3 Internal mammary L N Cloy
Es
press
Rotter's
LymphNode3 interpectorial N Bw pmajor and minor
Tx Pf Lady comes with Breast Lump
triple Assessment
L u
Histopathology
Historyandphysical Radiological
ExaminationTest Test I
IFNAI 23 30gauze
Needle
40412 740412
USG
t t
Mammogram
l
CBC2young pimps Have Drawbacks
Dencetissue mammogram Highfalse ve
Notsensetive it can Not diagnosed bw
in situ invasive cancer
I One forBreast lumps True
cut Biopsy CoreNeedleBiopsy
insicional Biopsy Technique
Exsicional Biopsy
GoldStandered investigation
C C coaniocaudal
2 views
Or
Mio Mediolateral oblique Show Max
tissue
Latest BEST3
3D Mammo Tomosynthesis
mammography
a
Screening Diagnostic
I
Best screening modality 40yrs
start at 404 r
v so
Best investigation To diff B w solid Uf cystic lump
in a pregnant Lady with Breast Lump
Pathology f Br cancer
1 is
sporadic got family lot
1Brc YBR
179 139
Breast cancer S
ovarian ca
pancreatic
dialogism.me
nonaggressive
poor prognosis Basalsubtype
4130 1stdegree
should be screened
1
BRCAmutation
t
Lifestyle changes
Wt loss
RegularExersice
Giveup smoking Alcohol
MRI screening
I
BIL salpingoophrectory
TAMOXIFEN
SERM
13ft prophylactic Bso
mastectomy
t ovarian BR ca
I BRCANCER
IHC immunohistochemistry
f t ki
PRO HERai
proliferation
1 d index marker
Estrogen progesterone
Receptor Receptor
t t Low
luminal
Mrc
Bestprognosis
Luminal t t t LowlHigh
B
Basal
High
CthpleNegative
CTNBC d
worst
prognosis
mostaggressive
HER 2 High
ENRICHED
TNM staging of Baca
Tuznor
To No tumor
Tis in situ 7 DCIS ductal Ca in situ
Lets Lobular 11 Now NO
Longer in situ
Paget'sdisease
it's Benign disease
Ta
t t
t t
ChestWale Skin
Dimplingf A inflammatory
p Mayor C J Breast ca
minor C I RetractionC 3
worst prognosis
S anteriorCt ulcerationCt
IIcmuscle t p dorange Ct
RIBS Ct satellite t
Modules
No NO LN
N Mobile Axillary LN
Nz Infraclavicular supraclavicular L N
Mo No distant Metastasis
My
M c site of distant metastasis BONET
I
Wich Bone Vertebral Column
Why Batsonpspiexusqvelns
wi.ch vertebrae Lumber Thoracic
Q
MII
MII
USG
Tryout Biopsy
MRI
USG
LRR 4 I
local Regional
Recurrence
u
Radiotherapy is
mandatory
Bfs Lumpectomy
J
Oldmargin New Latest
ammo
CIIfogBcs f Technical
to Rt
pregnancy multifocal multicentric
SLE Rheumatoid Lobular cancer multicentric
PriorRT Exposure to Largetumor Breast Ratio
chest wall
Mastectomy
S
Radical mastectomy Modified Radical
mastectomy
simplemastectomy
BREAST 1 MAC
Pfacia
L.nl are not Removed
complication Hemorrhage
Pug to Nerve CM.CN My during MRM ICBM
He
Intercostal Brachial Nerve
I
sensory Nerve to Axilla
I
Loss of sensation in Axilla
Mc complication SERoMA_
prevent Drain
if it develops Aspirateunder Aseptic condition
Lymphedema
I
show Sentineal L N
M c Nerve Pyured in S L N
Biopsy f Intercostal Brachial
Nerve
chemotherapy f given it
LN
t.op.ee
HERZNew Paclitaxel
Y
d
we add TRASTOZUMAB
SIE Hemorrhagic cystitis
Also ACROLIN Causes Hemorrhagic
cystitis
preventive Agent
MESNATX
Radiotherapy5 given it Hormonal therapy
1 BCS done I
2 it LN onlyin t t
L S
premenopausal Postmenopausal
Tamoxifen Aromatase
Ma
syrgery chemo RT 2 HT
Bcs GI
L J
GItrimester
in 45 in All
Mastectomy go Trimester
Bcs RT is
GI
Benigno
1 Breast Abscesse seen in lactating women
M.c organism Staph Aureus
Source oropharynx of child
or USG
2 Attempts
of Aspiration shouldbe done
1
if they fail incision and
drinage
11NOblade
fibroadenoma Mfc cause of BREAST LUMP
15 25 YR
firm lobulated
by user If
if Mammogram popcorn
calcification
I
surgery
1
It Pt is symptomatic
5cm giantfibroadenoma
Family History of cancer
1
PAREAREOLAR incision C cosmetically better
TX MASIALGIA 3
L J
cyclical Non cyclical
A
DX f USG t
MX I Intraleismal
Mx Lifestyle modification
Trigmcinolone
wt Reduction
Vit E 2 PRIMROSE Oil
capsule
Tf Not Respond
Lowdose Tamoxifen
Nippledischarge e
Mx surgery
Microdochectomy Removal
of a single duct and papilloma
Eczyma like
condition in NOdestruction
of NAC
Wichthere is destruction
of NAC B c
02 No Lump
70 With Patients Have
Underline Lump
Sometime
Mostly Deeg invasivecancer
B DxS punch Biopsy
1
Pagetcells in epidermis
ER PR 0
CEA
Mx L s
Lympectony simplemastectomy
Gynecomastia enlopymet of male Breast
Physiological Pathological
Klinefeltersyndrome
Cfoshosis
paraneoplastic syndrome
Hcc
Rcc
Testicular
DX 8 USG
Mx liposuction t Gland Excision
ORALCANCER8
Mrc site
India world
Pathology e
Riskfactor8
smoking TOBACCO chewing Alcohol
HPV EBUG SHARP ILL FITTINGE
DENTURE
Nasopharyngeal ca
condition
premaligned
Morecommon 3 5 time
Leukoplakia whitepath cannot be Rubbed off
Erythroplakia Red patch
pharyngeal Sc c of esophagus
cancer
done CE
Staging by
Me d X
chemo
RT
surgery
I 5 FU d Local
Recurrence
widelocal Exsicimof cisplatin
Ptumor
site Distantmetastasis
old New goprofft
Mfc of I
P
E Lungs
2cm 0.5cm
if mandible inv
2
Mandibular Resection
MII prognostic factor
Lonstat
3 it LN
Neck bisection
4 Reconstruction
Upperdeep cervical we
Bymanual palpation
111 mid diff1 B w gland
IV Lower 11 L N enlargement
DigastrickufzignYigular
M.astoIDg
B Antdigastric
9
Oe j submental D
HYOID
level IA
Submental L.nl
L 5
3 supomohyoid
again Spats L N6 Central
levee compartment
P ipranihaenuirini
CLAYICLE
k
TufomohyaI
Iastinal L N
n Medi
Neckdissection
f b MRND modified Radical
Radicle Neck Incision 3 Modified SCHOEBINGER
dissection
CRILE LV l 5 LN
by
w 2 to 5 But we save at least one extra
3 ExtraLymphNode Lymphatic Structure
Structure
SCM o Ijv o
spinalA N
complicationof N D
1 Hemorrhage
X X X X
submandibular s popatoid
I O.c NCCT
Mx surgery
Paratoid 90 10
Submandibular 50 50
Sublingual 20 Soyo
minor 10 904
PARAIOID
M c Benign tumor in paratoid pleomorphic Adenoma
MfcTumor overall
pleomorphic adenoma 2
Dx by FN Ac
Histopatho Epithelial and mesenchymal component
My superficial parotidectomy
sometime mixed
malignant change malignat timer
signs Rapid Tin size
pain
Ulceration
fire of LN
investigating of facial N
Dx by E FNAC
Mx surgery followed by Radiotherapy
Warthen's tumors
Adenoma Lymphomastum
10 f Canbe B L
M F
DX by FNAC
Extent MRI CT
Mx sup paratoidectomy
2nd M c u m Adenoid
cystic
cancer
paroidectomy
complication
I Hemorrhage
2 Trying to Nerve
Marginal mandibular N
Facial N Involved
Greater Auricular Nerve
1
leads to Anesthesia over angleofmandible
3
freysyndrome gustatorysweating
11
sweating over paratoid Region when pints think
offood eatsfood
prevent 8 o Scm
M flap
Digastric
Me Tumor of submandibular gland pleomorphic
adenoma
Investigation
1st investigation CTzftylTSH
USG Neck
I O.c FNAc
I
Drawback can't d F b w follicular
Adenoma
v
follicular carcinoma
Normalthyroidscan
Thyroidscan
indication
1 Hyperthyrodism 2 LowTSH
2 Ectopic Aberrant thyroid tissue
DrugsFIBsurgery
Non Functional
Nodule
0 08
Plummer'sdisease
DJ
Rx DrugsFIB
RIA
00
G O
1
Hyperfunctional diffuseduptake
Nodule
Retrosternal goitre
Thyroglossaf
cyst Remnant of tyroglossal tract
i tegmen
A
if tract persistthen thynglossal
Cystoccurs
M c location Subhyoid
carcinoma
Thyroidcancer
I papillary thyroid cancer PTC
Tends to be multifocal
s Hematogenous
Lymphatic
K H
Lov 6 of M C Lungs
Centralcompartment
indelphian
Dx by Oo FHAC
othercancer3 a PTC
psammomabodies
Meningioma
protection ma
Mesothelioma
papillaryRenal cell ca
adenoma
Serous cyst of ovary
D DXby FNAC
Mx by surgery
1
If PTNs is L 40 4 r C 2cm tumor Unifocal
Nocapsular invasion
1
them do HEMITHYROIDECTOMY
waitfor 4 6 Weeks
L
Wholebody Ia Scan
If Residualdisease Metastatic disease
S
0
Radioactive Ablation
followup
by I 1317 a 6months
prays the dogs
78
USG
sothyroglobwin
a
Tumormarker for differentiation
of
thyroid cancer
CIF E o
thyroid swelling
Hematogenous Lymphatics
4 ANAPLASTIC cancer
e
worst prognosis
in5th 16th decade
Rapidly growing thyroid swellings
Shows
D by 8 FNAC
My8
c S
DABRAFINIBTIC
MTC
Familial
sporadic
MEN 2 Syndrome
Aggressive tumor
Multifocal
Lymphatic Hematogens spread
M C site Lives
swelling
Diarrhea Serotonin
Flushing Histamine
mic
IT
Amyloid Rich Stroma
D by f FNAC
t other L N
fx
there is NO ROLE Of Ig SCAN and Radioiodine
Ablation
MEI syndrome
MEN 01 Wernersyndrome
chromosome Chr H
Ch
L J
MTC
MEN2CA
only Sipplesyndrome
MedullaryThyroid ca CM
pheochromocytoma
parathyroid adenomas
02 B AK A MEN 3
MENI Syndrome
MTC
Mucosal Neuromas
IncisionUse COLLARI
position Ii I ROSEPOSITION2
Types
Hemithysoidectomy
Lobectomy
D fishmuseetony
D total
YOBBOS Yama
Near total
subtotal
HARTLEYDUNHILL
procedure
complication P Hemorrhage
Trying to External laryngeal N S RLN
4 Bc of B
I
t
f
Hoarsness
Litethreatning
Hoarsness
3 Postop Respiraty distress due to
causes
Laryngealedema Mrc
Tension Hematoma Remove suture and
evacuate Hematoma
Layngeomalasia
131L Laryngeal N Ryung
U Hypoparathgrodism
vascularinsult to p gland
Tetny
t
Respiratydistress
2
sign
I TrossAUSIGN8 carpopedal spasm or
obstretician Hand
deformity
2 CHOUSTEKSIGNS facial facial spasm
MX I L
if severesymptoms or
if minorsymp s can s
8mgIdl
S card S
8mgIdt I v calcium gluconate
oral ca 2 oral VitDg oral cat
oral Vit133
Joli's thyroid Retractors
intraoraltysodotomy
Hypethysodism I weightgain
constipation
coldintercourse Alopesia
Lethargy Menorrhagia
Bradycardia
I Tz Ty I TSH T
causess
m Iadeeficieng
In Western HASHIMOTOTHYRODITIS
Mx Thyroxine Replacement
SUBACUTE THYROIDITIS
But it is a
self limiting condition
I
In a Few Months follicle Regenarate a
Euttyroid state
supportive care
Reidatthyneditis 8 CFTbrosingthyroditis
t t
fibrous withingland vicinity of gland
t
RIN Hoarseness
Hardthyroidswelling
Trachea stridor
causes e Me Gravesdisease
2
solitary toxic Nodule
3 Toxic Modular goitre
4 TODBASDOW'S PHENOMENA
Iz induced Hyperthyroidism
6 Struma Overii
7 TSH secreting pituitary adenoma
t
Drugs Drugs fW
Drugsonly RIA
tfw surgery
f b
Carbimazole
PTU
Tafeiffegnency
Agranulocytosis
Drugs are given 6 8
Weeks before intervention
any
I continious 7
day after Sy to prevent
THYROID STORM
propanol01 also added
a
I vasculary
Shrinkthegland
MC
of Death in thyroid
causes
storms Arrythemia
GRAVEL diseases
M c causes of Hyperthyroidism
AI condition
AutoAb Against Thyroid Receptor
stimulatingAb
L Long Acting Thyroid Stimulating Ab
Diffuse Goitre
Eyesign
Exopthalmus so STEALWAG
signCPufrequent Blinking
Lid Retraction Lid Lagevon spasm of Muller
GRAFFE muscle
sign Autonomic componentor
Lps
JOFFORYsign Absence
of Forbead Wrinkles on upward
gaze
Loss Accomodattoy
MOEBIUS sign of Reflux
pretibial myxedema
Thyroid Acropathy
solitary thyroidmodule
M.c causes colloidAdenomae
2nd M c causes Follicular
1st investigation Thyroidfunctiontestct
Ioc FNAL
Retrosternal goitre
swelling
dyspnea
Stridor
Lower limit can'tbe Reached
Pemberton's sign
IO C CECT
Hyperparathyroidism
Bong Pathological
Browntumors Osteitisfibnosa cystica
Stones Renalstone I oc NcCT
test8 SoPTH AT
S Cq y y
S phosphate it
L J
Adenoma Hyperplasia
Tagg
Sestamibi
scan L
1 surgery
surgery I
Removal of Remove342 Glands and we
singlegland Auto
transplantation
ofthe Remaining
Gland
vito
If Id condition
Ica 12 Absorption
16 Y'gyevegible
we correct CRF
Is.ca and give
11 ORAL Vit D3
PARATHYROID
HYPERPLASIA
30 Hyperparathyroidism
e
Mx I correction
of CRF
Removal of Gland
TX PseudoHyperzaralytodism
Hypercalcemia of malignancy
More PARANEOPLASTIC
syndrome
me cancer s c c lungs
VASCULAR SURGERY
EnothelialKyung
Hypercoague
State
R previous 4 0 DVT
Trauma
pregnancy
I I
PainfulWhitelimb a painful bluelimb
thrombosisof majorAxialveins collatrels are spared
collatrols
Me vein involved n
Mnc vein in Wich DVT give Rise to p.EE all
199
Femoraliy
me symptom pain
M c sign
Limbedematx
signs
1 Homan Painon doositlexiong foot
2 MOSES pain on squeezing calf
I O.c Duplexscan
Mx
First 5 days LMWHTWARFARIN2
f limb
Venous
system of lower
b
sup Goy deep soy
l perforators
100 150 y
VARICOSE VEINS e
mm mm
TX 3 COCKETT 5 CM
from m
to cm
15 CM
mayestKuster Heels
Dilated veins
of Varicose vein
Tortuous veins
Test
for is SFJ competent or Not
Trandelenburg's test
are perforator 1
I o C J Duplex scan
MX I Traditional
c u surgery
1 GSU SFI 2 SSU SPJ
incompetence DODD COCKETT
incompetence
procedure
Traditional surgery Traditionalsurgery
Ligation of
TRANDELENBURG FlushLigation of Perforators
SURGERY SPS
I cosmetically inferior
11
Flushligationof SFJ
Nostripping
stripping is
Additional µ seepsg
but only done Above Latest Subfacial Endoscope
the knee EULT Perforatorsurgery
RFA H
Latest Latest
I
l Endovenous lasertherapy EULT
RFA
Radiofrequency Ablation
TRIYAX Sfc Piuminator
I
we took out Vein and ligate
Foam feterotherapy I
3mm in diameter varicose Vein
f 3 MM i Reticular 4
M c Eelenosing
Agent Nattetradecyl
f
sulphate
complication of surgery
M c Bruising
injury to Nerve
it 11 Femoral
11 11 11
1 Bleeding 3 pigmentation
2 Calcification 147 Lipodermosclerosis
varicose Ulceron
o O
Theory Ambulatory venous HTN theory
features a shallow Ulcer
Sloping edges
pale granulation
oftissue
My BISGARDREGIME
l Education
of patients
elevation of limb
3 elastic compression stockings
4 Dressings
5 surgery Margolin's ulcer AA
BUMP scar
longstanding venous Ulcer
Margolin's ulcer
I
in squamous can ca
Ulcer's
punched syphilis
Diabetic
Neuropathic Ulcer
Bedsore
Arterial
J underminded TB
cc
like
ARTERIAL SYSTEM
source Heart
8 Eps p pain
p pallor
P paresis
P paresthesia
p poikilothermic
p pulselessness latefeatures
I o c Duplexscan
Mx I 4
Early late
II I
with in 6 steps gangrene
I
Embolectomy Amputating
1
by
Fogarty's
Ballon
catheters
chronic Arterial occlusion g
E to thrombus collated
gradual phenomey f
Intermittent claudication
I 2 CKD DM
I I 2
0.9 intermittent claudication
Lo 3 critical limb ischemia CRestpain
co Rest pain
Burger'sdisease Atherosclerosis
oblitopigns
thromboIgitis
M F or
M F
smoking
or LL UL
LD UL 5th decade
3rddecade only involve
ANEYRYSM
M c peripheral popietal
Me visceral vessels splenic
M c vessels in mycotic Aneynysm Aorta
m c organism stgohaureus
Raynaud's phenomena
1
Vasespasm
phase I phase 2 phase 3
Atv inspasm ARelex v inspasm A 1 V Both
Relax
white pale Blue pain Red
AN fistulae causes
traumatic
congenital
Mfc Iatrogenic
dialysis
f
Radiocephalic
C Cimmino
pulsatile swelling
palpable thrill
it in a limb 2 Hypertrophy of limb
congenital fistula
MX Ft symptomatic
Angloembolization
fails
Hypertrophy
surgical ligation
HERNIA I
mm
protrusion of viscus or part of
viscus through Wale containing it
cough impulse 0
B Blood supply to content is intact
Based on content
omentum omentocele
easyto Reduce 1st part
difficult to Reduce 2ndpart
Meckell diverticulum Litters Hernia
Appendix Amayant
Inguinal Hernia 8
of 07
But femoral is more common in IFSMT
HASSELBACH A
L j
through Lat
direct indirect
Mx surgery
HERNIOTOMY
Ann
identyty and cutaccess
tax
Wedo nothing
opensact push sac close to defeet
contentsinside Sac 11
therewin Highest Recurrence
But it is T.o.ci inguinal Hernia in children
congenital Hydrocele
2 HernIorraphy
I 2 13J we suturedefect togather
in obstructed strangulation
He
Bez MESH can't Use in infection
Hernioplasty I 2 IMESHI
proline
Least Recurrence
2
M c ihyural Nerve Pieoinguinal
3 MC ENTRAPTTED Nerve Pleohypogastric
Beneathmesh pain
4 Trying to UAS
Special type of inguinal Hernias
Clinically diff b w
Inguinal femoral
pubictubercle
L Belowand lateral
Aboveandmedial
s surgery
Low
High
Lockwood
Me Evedy
Strangulated uncomplicated
Open Lap
Hernioplasty
3 UMBLICAL 4 PARAUMBLICAL
Herniae
Maydal's O
Morethan one bowel loop
Hernia
W shape
it strangulation occurs it inv
the connecting portion 8 it can
be missed
Richter's Hernia
VeryNarrow defect
strangulation is commey But to
obturator