Welcome ! I'm Dr. Ahmad and I will be pleased to offer help.. email me: ad_icare@yahoo.com أهلا و سهلا: يسعدنا إنضمامك لنا من خلال صفحتنا على الفيس بوك: استشارة صحية

Surgery notes , to be always remembered

Tuesday, 23 March 2010

Hernia
Q. Define hernia
Protrusion of any viscus from its normal cavity through an abdominal opening

Q. What are the types of hernia ?
Ans: Inguinal , umbilical , paraumbilical , femoral , incisional

Q. What is the difference between direct and indirect inguinal hernia ?

Ans: Indirect inguinal hernia



direct inguinal hernia


If the difference isn't clear yet , then better watch this video:




Q. Why is it common for inguinal and femoral hernia to occur on the right side more than the left side ?


Ans: The right testis descends into the scrotum later than the left. The processus vaginalis is , therefore, patent for a longer period and atrophies later than the left side. In addition , the sigmoid colon on the left side protects against possible herniation.


Notes:

--> Hernia are the most common cause of intestinal obstruction worldwide

--> Femoral hernias are irreducible

--> Pantaloon hernia : a combination of direct and indirect inguinal hernia. It is also called hernia en bisac

--> Maydl's hernia: W shaped hernia . During surgery , it is important to pull on the medial limbs as the gangerenous loop may not be within the sac.


--> Richter's hernia: a hernia in which the content of the hernia is a part of the circumference of an intestinal loop





Thyroid gland

--> Muscle of the larynx not innervated by the recurrent laryngeal nerve:
Cricothyroid muscle (innervated by superior laryngeal nerve)

--> Ophthalmologic signs of hyperthyroidism:
Exophthalmos , Lid lag , Lid retraction , Periorbital swelling

--> Treatment of thyroid storm:
IV fluids , Hypothermia , Acetaminophen , Propranolol , Propylthiouracil, Iodine

--> Why is the pulse pressure wide in patients with thyrotoxicosis ?
Due to increased blood flow and vasodilatation.

--> What voice problem will a patient have if there is injury to external branch of superior laryngeal nerve ?
Loss of high-pitched tone (cricothyroid makes the vocal cords tense so increases the pitch of voice tone.

Q. What are the types of simple goiter ?

Ans. Nodular and Diffuse

Q. What are the types of toxic goiter ?

Ans. Diffuse (primary) , Nodular (secondary) , Toxic nodule

Q. What are the types of malignant goiter ?

Ans. Follicular , medullary , papillary , anaplastic


Q. What will be the result of thyroid hormones level in Simple nodular goiter?

Ans. Normal.

Q. Why are anti-thyroid drugs contraindicated in retrosternal goiter?
Ans. Because antithyroid drugs cause enlargement of the thyroid gland that may cause pressure manifestations.
Q. Why is retrosternal goiter common in males ?
Ans. Due to strong strap muscles and short neck than females.




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