Surgery-Urology -Notes with Complete
Solutions
General
-Age >50 not favoured,
All paed amputations considered
-Comodbidities e.g Diabetes
Contraindications
-Multiple level amputations
-Unstable patients with other life threatening injuries.
-Single digit proximal to FDS insertion
-Self inflicted
- ANSWER-Anal abcess
- ANSWER-DDX of Tetanus (italics- common ones)
ENT
TMJ
peritonsillar abcess
Tox
-Strychinine poisoning
-Serotonin syndrome
-Malignant Neuroleptic syndrome
-Dystonic reaction (e.g Phenothiazines)
Infections
Rabies
Meningoencephelitis
Others
Hypocalcemia
Stiff person
- ANSWER-kidney stones- indication for admission(T)
# Perforated Appencicitis-Historical features
Appendicitis
-More rapid progression of disease in < 2 year old
-observation not advisable
, •Appendiceal perforation rate
-80% in infancy - 4 years - ANSWER---> 36 hours duration
-diffuse
-Less likely to localise to the right lower quadrant
•Pain free interval in 5%
•Vomiting, fever, alteration of bowel habit occur more often in patients with perforation
#Cellulitis Risk factors
-CKD
-Cirrhosis
-Venous insufficiency
-Leg oedema
-Obesity
-Lymphoedema
-Neutropenia
-Immunocompromise - ANSWER-#Fournier's Gangrene-Organisms
•Bacteroides fragilis and E. coli the most common
•Anaerobic Streptococci
•Gram negative rods (Vibrio,
-E coli, Klebsiella, Enterococci
•Anaerobes
-Bacteroides,Fusobacterium
Treatment
IV antibiotics
-ceftriaxone 2 g IV
-metronidazole 500 mg IV
-gentamicin 4-6 mg/kg (adjust according to renal function)
#CT findings of mesenteric ischemia
#AXR Findings of Mesentric iSchemia
-Ileus with multiple fluid levels
•Involvement of right half of large bowel if proximal superior mesenteric artery lesion
•Thickened bowel wall or gas in the bowel wall may seen as a late sign
•Thumb printing of mucosa on plain films secondary to mucosal oedema is another late
sign
•Pneumotosis intestinalis - ANSWER-1)Bowel wall thickening
-Most common but least specific finding
-May have a target or halo appearance
-More prominent in venous occlusion
Solutions
General
-Age >50 not favoured,
All paed amputations considered
-Comodbidities e.g Diabetes
Contraindications
-Multiple level amputations
-Unstable patients with other life threatening injuries.
-Single digit proximal to FDS insertion
-Self inflicted
- ANSWER-Anal abcess
- ANSWER-DDX of Tetanus (italics- common ones)
ENT
TMJ
peritonsillar abcess
Tox
-Strychinine poisoning
-Serotonin syndrome
-Malignant Neuroleptic syndrome
-Dystonic reaction (e.g Phenothiazines)
Infections
Rabies
Meningoencephelitis
Others
Hypocalcemia
Stiff person
- ANSWER-kidney stones- indication for admission(T)
# Perforated Appencicitis-Historical features
Appendicitis
-More rapid progression of disease in < 2 year old
-observation not advisable
, •Appendiceal perforation rate
-80% in infancy - 4 years - ANSWER---> 36 hours duration
-diffuse
-Less likely to localise to the right lower quadrant
•Pain free interval in 5%
•Vomiting, fever, alteration of bowel habit occur more often in patients with perforation
#Cellulitis Risk factors
-CKD
-Cirrhosis
-Venous insufficiency
-Leg oedema
-Obesity
-Lymphoedema
-Neutropenia
-Immunocompromise - ANSWER-#Fournier's Gangrene-Organisms
•Bacteroides fragilis and E. coli the most common
•Anaerobic Streptococci
•Gram negative rods (Vibrio,
-E coli, Klebsiella, Enterococci
•Anaerobes
-Bacteroides,Fusobacterium
Treatment
IV antibiotics
-ceftriaxone 2 g IV
-metronidazole 500 mg IV
-gentamicin 4-6 mg/kg (adjust according to renal function)
#CT findings of mesenteric ischemia
#AXR Findings of Mesentric iSchemia
-Ileus with multiple fluid levels
•Involvement of right half of large bowel if proximal superior mesenteric artery lesion
•Thickened bowel wall or gas in the bowel wall may seen as a late sign
•Thumb printing of mucosa on plain films secondary to mucosal oedema is another late
sign
•Pneumotosis intestinalis - ANSWER-1)Bowel wall thickening
-Most common but least specific finding
-May have a target or halo appearance
-More prominent in venous occlusion
