2013-11-10 | best for all medical and surgical blog

Malignant mesothelioma

Malignant mesothelioma

Causes

Malignant mesothelioma is the most common type of tumor of the pleura

In 20% of malignant mesothelioma , the tumor arise from the peritoneum

Exposure to asbestos is the only known risk factor it can be established in over 50%of patients geographic areas of increased incidence are frequently associated with industries using asbestos in the manufacturing process such as shipbuilding

ACUTE PANCREATITS

ACUTE PANCREATITS

Definition

This is acute inflammation of the pancreas which range from very mild and self limiting to fulminant and fatal

The incidence appears to have increased over the last 40 years in the UK the condition is a common cause of acute abdomen requiring hospital admission . the overall mortality has remained unchanged at 10%, in approximately 75%of patients complete recovery occurs after a few days of bed rest and alimentary rest however in the remainder the attack is severe with mortality of 25-3-%

Epidemiology

. Clinical series under report the incidence as cases diagnosed at post mortem are omitted. the incidence varies in relation to alcohol consumption which is the main cause in the young and the prevalence of gall stones which is the predominant cause in the elderly in many cases no cause is evident and these idiopathic cases are often referred to as the third most common cause of acute pancreatitis

UNDESCENDED TESTIS

UNDESCENDED TESTIS

Introduction

Evidence suggests that the incidence of infertility in undescended testes is reduced by early placement of the testicle in its natural location within the scrotum .orchidopexy is usually performed between 1 and 3 years of age in an attempt to promote normal subsequent development

Definition

confusion arise in the classification of this condition an undescended testis is any testis that fails to descend into the scrotum , and it includes those which adhere to the normal path but fail to descend fully (incomplete or arrest descent )as well as those found in locations remote from the normal path (ectopic) .approximately 3%of male infants have undescended testicle at birth whereas this figure drops to 1%by the age of one year . ectopic testes account for 10%of extrascrotal testes . they usually lie in one of four positions 1- superficial inguinal 2- base of penis 3- perineal 4- femoral an incompletely descended testis can be intra abdominal intracanalicular emergent or
highscrotal

Testicular Developement

The testis originate from the posterior abdominal wall mesoderm the urogenital (wolffian)ridge and migrate into the scrotum by the inguinal canal they are directed along this path by the gubernaculum . the accepted theory is that failure to follow the correct fibromuscular gubernaculum produces an incompletely descended testis

Incidence

genuinely undescended testes (cryptorchism) occur in 1%of males however 4-5%of males undergo orchidpexy

DIAGNOSIS OF PREGNANCY BY ULTASOUND

DIAGNOSIS OF PREGNANCY BY ULTASOUND

FIRST TRIMESTER ULTRASOUND :LANDMARKS OF FIRST TRIMESTER ULTRASOUND INCLUDE
1- Gestational sac: menstrual weeks 5 weeks by trans vaginal ultrasound (TAS) 6WEEKS TRANS ABDOMINAL ULTRASOUND(TAS

HIRSUTISM CAUSES AND TREATMENT

HIRSUTISM CAUSES AND TREATMENT

Definition

HIRSUTISM

Is common and often unrecognized it mean excess hair growth from androgen stimulation in female in abnormal sites like chine similar to men

Virilization

More severe form of hirsutism with accompanying clitoromegaly enlarged of clitores
male type pubic hair
temporal balding
deepening voice

PHYSIOLOGY OF HIRSUTISM

Androgens are derived from ovary and adrenal gland
adrenal gland seceetes dehydroepiandrosterone DHA),dehydroepiandrosterone sulfate(DHAS) ,testosterone

CLINICAL GENERAL FEATURES OF HYPERTHYROIDISM

CLINICAL GENERAL FEATURES OF HYPERTHYROIDISM

Clinical general features of hyperthyroidism can be divided into

A-General Examination

As 1-underweight 2-cutaneous changes as profuse sweating flushed face moist warm extremities (palms are warm and sweating contrary to psychoneurotics in whom the hands are
cold and sweating )falling of hairs ,pretibial myxoedema it is thickening of the skin by a mucin - like deposit nearly always associated with true exophthalmos and high levels of TsAb it is usually symmetrical the earliest stage is a shiny red plaque of thickened skin with coarse hair which may be cynaotic when cold in severe case

symptoms of toxic goitre or throtoxicosis or hyperthyroidism

Symptoms of toxic goitre or throtoxicosis or hyperthyroidism

the term thyrotoxicosis is retained because hyperthyroidism as symptoms due to a raised level of circulating thyroid hormones is not responsible for all manifestations of the disease

Causes

the incidence of the disease is more common in female than male main causes is due to autoimmune disease so

Large bowel obstruction

Large bowel obstruction

Causes

large bowel cancer accounts for up to 80-90% of cases of large bowel obstruction most occur at or distal to the splenic flexure

other causes include diverticular stricture diverticulitis
involving small bowel ,volvulus and other rare causes incarcerated sliding hernia ,radiation or ishaemic and strictures

Colonic and rectal malignancies

treatment depend on the condition of the patient ,condition of the bowel to be used in anastomosis and the skill of the surgeon .shock and circulatory instability of the patient and peritonitis may dictate a staged procedure.as hartmann,s procedure like wise a staged procedure may be

RISK FACTORS OF BREAST CANCER

RISK FACTORS OF BREAST CANCER

what are the risk factors of cancer breast

Including the following

Family history

women with a family history of breast cancer in a first or second degree relative are at increased risk for developing the disease the risk increase up to 1.5 - 3 times if a mother or sister has the disease

parity and age at menarche

At first birth parity and age at first birth are other endogeous hormonal factors that influence breast cancer risk nalliparous women are at a greater risk for breast cancer with women whose first pregnancy occurs after age 30 having a twofold to fivefold increase in breast cancer risk compared with women having a first term pregnancy before age 18 0r 19

Age at menarche age at menarche and the establishment of regular ovulatory cycles seem to be strongly associated with breast cancer Risk it is suggested that 20%decrease in breast cancer risk exists for each year that menarche is

INCISIONAL HERNIA

INCISIONAL HERNIA

Causes complications and treatment

incisional hernia occur when a weak surgical or traumatic wound allows the protrusion of peritoneal sac the swelling appears which gradually enlarges the hernia may affect the whole wound or just one portion mostly the lower . the content of the hernial sac may become irreducible and attack of subacute intestinal obstruction incarceration and strangulation may follow the overlying skin may become thin atrophic and

LOWER GASTROINTESTINAL BLEEDING

LOWER GASTROINTESTINAL BLEEDING

Introduction

bleeding may occur from any part from the gut .blood loss may be chronic and occult bleeding resulting in anaemia .overt blood loss varies widely in presentation .excluding haemorrhoidal bleeding .the lower gastrointestinal tract is less commonly a source of overt major
bleeding than the stomach or duodenum

TREATMENT OF ANAL FISTULA

TREATMENT OF ANAL FISTULA

treatment strategy consists of drainage of pus collections during acute stage (abscess)and eradication of all fistula tracts with
maximum preservation of sphincter muscles soon afterwardS

FISTULOTOMY WITH OR WITHOUT SPHINCTER REPAIR
fistulous tracts may be eradicated by excision or coring but this is rarely practised nowadays as laying open of tracts with curettage of blind tracts and cavities often achieve si

CAUSES AND TYPES OF ANAL FISTULA

CAUSES AND TYPES OF ANAL FISTULA

CAUSES OF ANAL FISTULA

Most anal fistula result from pyogenic anorectal abscesses some are secondary to specific causes such as Crohn,s disease TB or carcinoma rarely they are secondary to actinmomycosis or lymphogranuloma venerum

Clinical features and diagnosis

anal fistula and abscesses

the most frequent symptoms are anal discharge pain and swelling .discharge tend to occur intermittently while swelling and pain are usually associated with abscess formation when the external opening is closed clinical examination may reveal the presence of one or more external openings discharge and soiling of underclothes .bidigital

Management of deep venous thrombosis

Management of deep venous thrombosis

preventing first prevention of deep venous thrombosis as 1- general measures early mobilization , hydration 2- mechanical methods graduated compression stockings perioperative pneumatic compression electrical calf stimulation ,intermittent foot compression all reduce the incidence of perioperative DVT 3- pharmacological , warfarin - postoperative bleeding can be troublesme low- dose heparin (5000 in b.d) is effective in

CHEST TRAUMA

CHEST TRAUMA

Causes and introduction of chest trauma

Chest injuries may be blunt or penetrating blast injuries frequently involve a combination of these

Fewer than 15% of chest injuries require surgery tube thoracostomy ,blood or fluid replacement oxygen therapy and analgesia are the mainstay of treatment in most patients hypoxia is the final common pathway of most chest injuries and all patient should receive oxygen at an FIO2 of at least 0 .85 -

BLADDER OUTFLOW OBSTRCUTION

BLADDER OUTFLOW OBSTRCUTION

the pathology may be neuropathic due to the failure of the sphincters to relax in harmony with detrusor contraction or due to obstruction from bladder neck hypertrophy being prostate hyperplasia (BPH)urethral stricture urethral calculus meatal stenosis or a tight phimosis 1- urethral stricture once a urethral stricture always a urethral stricture this adage still holds good pharaohs even took dilators with them to their burial chambers for the after life the causes are numerous as 1- catheter urethral site penoscrotal mechanism by pressure necrosis and paraurethral gland sepsis 2- perineal injury urethral site bulbar mechanism by crush injury 3- pelvic fracture urethral site membranous mechanism by prostatic displacement shear injury 4- infection throughout urethra by gonorrhoea and chlamydia 5- BXO urethral site meatal mechanism by fibrosis 6- chemotherapy throughout the urethra by causing chemical urethritis 7- instruments throughout urethra either iatrogenic or masturbation 2- presentation depending on the degree and length of narrowing and

The deep venous thrombosis

The deep venous thrombosis

the significance of deep vein thrombosis(DVT) lies in its potential to cause pulmonary embolism and post-thrombotic calf pump failure .virtually all venous thrombi arise in the deep veins of the legs or pelvis .the incidence of DVT in the general population is approximately .5% where no preventative measures are employed .the incidence of DVT in general surgical patients over 40 years undergoing to major surgery is 30%and 60-80% in patients undergoing hip or knee replacement or surgery for hip fracture in patients recovering from myocardial infarction or cerebro vascular accident the incidence is 20-60% 1- aetiology VIRCHOW,S TRAID hypercoagulability antithrombin 111 deficiency ,protein c deficiency ,protein s deficiency factor v leiden ,antiphospholipid syndrome heparin co factor alpha 11 macroglobulin alpha 1 antitrypsin fibrinolytic impairment oral contraceptive .stasis as in surgery and bed rest. vein wall damage as in surgical injury trauma and radiotherapy risk factor include age sex race operation anaesthetic pregnancy trauma immobilization bed rest malignancy previous thrombosis obesity cardiac failure contraceptive pill congenital venous abnormalities .pathology thrombosis is frequently initiated in the vein valve sinuses of the soleal plexuses platelets adhere to the venous endothelium initially and fibrin and red cells are deposited between the layers of platelets giving rise to laminated thrombus this propagates to extend up th vein being free or loosely attached to the wall initially thrombus then become firmly adherent to the endothelium organizes retracts and recanalizes to varying degrees destroying the endothelium and valves as it resolve clinical features limb swelling pain tenderness erythema and dilated superficial veins are the classic signs but are frequently absent even in a major thrombosis a swollen white leg (phegmasia alba dolens)or blue leg(phlegmasia cerulea dolens

Head injury

Head injury

Pathology of head injury The Monreo-Kelly doctrine confirms that the skull cannot easily accommodate an increase in volume of its contents without a significant rise in intracranial pressure (ICP) .cerebral perfusion pressure (CPP)equals the systemic arterial pressure(SAP)minus the ICP this relationship is fundamental and explains the pathophysiology of brain injury .brain injury causes swelling .this volume increase causes a rise in ICP and thus a fall inCPP resulting in brain ishaemia . deterioration in cerebral function causes respiratory failure resulting in reduced PaO2 and rise in PaCO2 , which both