empyema necessitans
Things about portal hypertension in the surgery view point « Long ...
Jika masih aktif juga maka lakukan tampon dengan Sengstaken Blakemore Tube. Jika perdarahan sudah terkontrol mk kembali lakukan endoskopi skleroterapi dan terapi konservatif. Namun bila perdarahan kembali lagi maka sekali lagi lakukan ...
Gastroesophageal Reflux Disease
43 GASTROESOPHAGEAL REFLUX DISEASE
Michael E. Fenoglio M.D., Lawrence W. Norton M.D.
1. What symptoms suggest gastroesophageal reflux disease (GERD)?
Show answer
Substernal burning after meals or at night, associated occasionally with regurgitation of gastric juices, is one symptom. Discomfort is relieved by standing or sitting. Dysphagia, a late complication of GERD, is caused by mucosal edema or stricture of the distal esophagus. However, no symptom is specific for GERD, and therapeutic decisions should not be made on symptoms alone.
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Portal Hypertension & Esophageal Varices. Controversy
CONTROVERSY
32. How should a patient with known esophageal varices be treated to prevent an initial variceal bleed?
Show answer
The combination of beta blocker and nitrate is used for primary prophylaxis, but endoscopic band ligation is at least equivalent to pharmacotherapy without the side effects (one third of patients cannot tolerate beta-blockers because of fatigue or bronchospasm, and 20% cannot tolerate nitrates secondary to pounding headaches). These treatments reduce the incidence of an initial bleed from 30% to < 10% and the mortality from 30% to 20%. Endoscopic band ligation was previously suggested for prophylaxis only in class C disease, but mounting evidence suggests that EBL is more effective than pharmacotherapy in all patients. The effect of combined EBL and beta blockade in primary prophylaxis remains to be established but makes great intuitive sense.
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Portal Hypertension & Esophageal Varices
42 PORTAL HYPERTENSION AND ESOPHAGEAL VARICES
Ramin Jamshidi B.S., B.S., Gregory V. Stiegmann M.D.
1. Describe the blood supply to the liver.
Show answer
Total hepatic blood flow is roughly 1500 mL/min, or 25% of cardiac output. The hepatic artery normally supplies about 30% of blood flow, and the portal vein contributes 70%. The hepatic artery and portal vein each supply 50% of the liver’s oxygen, however. With portal hypertension, portal flow decreases and the relative contribution of the hepatic artery necessarily increases.
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Diagnosis & Therapy of Chronic Pancreatitis
41 DIAGNOSIS AND THERAPY OF CHRONIC PANCREATITIS
Clay Cothren M.D., Jon M. Burch M.D.
1. What is chronic pancreatitis?
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The classic syndrome consists of smoldering abdominal pain and evidence of pancreatic insufficiency. Histologically, chronic inflammation results in destruction of the functioning endocrine and exocrine pancreatic cells.
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Acute Pancreatitis
40 ACUTE PANCREATITIS
Clay Cothren M.D., Jon M. Burch M.D.
1. What are the common causes of acute pancreatitis?
Show answer
Gallstones (45%), alcohol (35%), and other (20%).
2. What are the uncommon causes?
Show answer
Hyperlipidemia, hypercalcemia (hyperparathyroidism, multiple myeloma), iatrogenic factors (endoscopic retrograde cholangiopancreatography), drugs (didanosine, thiazide diuretics, H2 blockers, tetracycline, azathioprine), infections (mumps, coxsackievirus), pancreas divisum, and scorpion bites (favorite pimp question on rounds). Approximately 10% of cases are considered truly idiopathic.
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Pancreatic Cancer
39 PANCREATIC CANCER
Nathan W. Pearlman M.D.
1. What are the general features of pancreatic cancer?
Show answer
There are about 30,000 new cases per year in the United States, and more than 29,000 deaths, so it is a highly lethal disease. In most cases, histology is adenocarcinoma. About 80% arise in the head of the gland, and 20% arise in the body and tail. About 20% of patients have localized (potentially curable) disease at diagnosis; the remainder are inoperable either because of regional spread (portal vein, superior mesenteric artery) or widespread metastases (liver, peritoneum). Read more
Gallbladder Disease
38 GALLBLADDER DISEASE
Jeff Cross M.D.
1. What is the prevalence of gallstones in Western society for women and men 60 years of age?
Show answer
Women, 50%; men, 15%, although there is formidable ethnic predilection with gallstones endemic in Native Americans.
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Appendicitis
37 APPENDICITIS
Alden H. Harken M.D.
1. What is the classic presentation of acute appendicitis?
Show answer
Periumbilical pain that migrates to the right lower quadrant (RLQ) in a patient who is anorexic.
2. Where is McBurney’s point?
Show answer
One third the distance between the anterosuperior iliac spine and the umbilicus.
3. What is McBurney’s point?
Show answer
The point of maximal tenderness in acute appendicitis.
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Pediatric Trauma
36 PEDIATRIC TRAUMA
David A. Partrick M.D., Denis D. Bensard M.D.
1. What is the leading cause of death in children in the United States?
Show answer
Injuries cause more death and disability in children from ages 1 to 18 years than all other causes combined. Unintentional injury deaths account for 65% of all injury deaths in children under 19 years of age. Each year, approximately 20,000 children and teenagers die as a result of injury and 50,000 children suffer permanent disabilities. Each year, nearly one child in four receives medical treatment for an injury. The estimated annual cost is $15 billion.
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Burns
35 BURNS
Paulus C. Bauling MBChB, M.Med., FACS
1. Why is it essential to have sound clinical knowledge of urgent and emergent burn care?
Show answer
The events of September 11, 2001, have vividly underlined the fact that wars, plane crashes, nuclear and industrial accidents, and many other potential disasters can produce large numbers of burn-injured victims in an instant
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Basic Care Of Hand Injuries
34 BASIC CARE OF HAND INJURIES
Michael J.V. Gordon M.D., Lawrence L. Ketch M.D.
1. What are the goals of hand repair?
Show answer
Functional considerations override cosmesis in the treatment of hand trauma. There are no minor hand injuries. Initial diagnosis and management determine the final result; expert secondary repair cannot overcome primary errors in diagnosis or decision making.
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Facial Lacerations. Controversies
CONTROVERSIES
14. What controversies exist regarding the care and repair of facial lacerations?
Facial Lacerations
33 FACIAL LACERATIONS
Lawrence L. Ketch M.D.
1. What distinguishes facial from other lacerations?
Show answer
Appearance is clearly of primary importance. Quality of the final result depends on strict adherence to basic principles of wound management and painstaking technique. Copious irrigation, judicious debridement, gentle tissue handling, meticulous hemostasis, and minimization of sutures combined with early stitch removal are critical to an optimal result. Fine suture and sharp instruments should be used; eversion of the wound margin with layered closure, obliteration of dead space, and lack of tension are mandatory.
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Extremity Vascular Injuries
32 EXTREMITY VASCULAR INJURIES
Kyle H. Mueller M.D., William H. Pearce M.D.
1. What are the “hard signs” of arterial injury?
Show answer
* Distal circulatory deficit: ischemia or diminished or absent pulses
* Bruit
* Expanding or pulsatile hematoma
* Arterial (pulsatile) bleeding
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Lower Urinary Tract Injury & Pelvic Trauma
31 LOWER URINARY TRACT INJURY AND PELVIC TRAUMA
Fernando J. Kim M.D., Siam Oottamasathien M.D.
1. What are the causes of bladder injury?
Show answer
Iatrogenic manipulation and penetrating or blunt trauma. Because of the rich detrusor blood supply, bladder injury is usually accompanied by hematuria. Other signs may include suprapubic pain, inability to void, or incomplete recovery of catheter irrigation.
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Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
