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Showing posts with the label Surgery

Subtotal / total lobectomy, Hemi / subtotal / near total / total thyroidectomy

Subtotal lobectomy : resection of part of a lobe. Total lobectomy : resection of whole of a lobe. Isthmusectomy : resection of the isthmus. Hemi thyroidectomy : total lobectomy + isthmusectomy. Subtotal thyroidectomy : 2 x subtotal lobectomy + isthmusectomy. Near total thyroidectomy : total lobectomy + isthmusectomy + subtotal lobectomy. Total thyroidectomy : 2 x total lobectomy + isthmusectomy.

Pericardial effusion - Water bottle shaped heart

Fluid in the pericardial cavity is typically seen as a water bottle shaped heart. A pericardial paracentesis of only 15-30 mL can be very beneficial for the patient. This is done by using a syringe at a point 1-2 cm inferior to the left of the xiphochondral junction at a 45 degree angle to the skin and in the direction of the tip of scapula or shoulder. This procedure must be carefully carried out under continuous ECG monitoring.

X ray pneumothorax

X ray findings of pneumothorax include a discrete shadowed line beyond which no lung markings are present, as shown by the arrows. They usually occur at the apices which are the least dependent part of the lungs on erect posture. Inspiratory and expiratory films may aid in detection. In expiration, lung volume is decreased while that of the pneumothorax is constant. So there will be a relative increase in the size of the pneumothorax.

Relief of tension pneumothorax...

Assess the patient's chest and respiratory function. Administer oxygen at 12 L/min by mask. Identify the 2nd intercostal space in the midclavicular line on the side of the pneumothorax. If patient is conscious and time permits, add a little of L.A. Insert the needle of a 20 mL syringe attached.  Aspiration of air confirms the diagnosis. The syringe is remmoved and a hissing sound is usually heard as air is expelled rapidly. If you place your hand close to the needle, you can detect this rush of air. Doing this urgent procedure will convert a tension pneumothorax into an ordinary one. A wide-bore intercostal rube is then introduced laterally and directed to the apex of the pleural cavity. A second drain may be introduced basally to drain blood.  The site of insertion is in the triangle of safety which is defined as the anterior border of the latissimus dorsi, the posterior border of the pectoralis major and the superior border of the fifth rib. The area chosen is i

Courvoisier's law

QJGXPY3W4EAW It states that in a case of painless jaundiced patient, if the gall bladder is palpable, stone pathology is ruled out. This is because stone formation is a long standing process and this leads to fibrosis. A fibrotic gall bladder is not usually palpable. The causes are more likely to be a ca of pancreas, ca of ampulla of Vater or a cholangiocarcinoma.

Hesselbach's triangle

 IMPORTANCE  A direct hernia passes through the Hesselbach's triangle while an indirect one passes lateral to it. This area is the weakest because the abdominal here consists only of the transversalis fascia covered by the external oblique aponeurosis.  BOUNDARIES  As shown by the figure below: Inferiorly : Inguinal ligament Laterally : Inferior epigastric artery Medially : Lateral border of rectus abdominis.  HOW TO DO THE TEST?  To confirm this we can do a ring occlusion test whereby the deep inguinal ring is occluded at 1.25cm above the midpoint of the inguinal ligament after reducing the hernia. Now we can ask the patient to cough or stand up. If the hernia is seen even though the deep ring is occluded it means that the hernia is of the direct type. First published on : 4 May 2010 Last reviewed on : 2 May 2020