International surgical boards

2022-08-31 23:15:24 Sclerosing mesenteritis

It is a rare inflammatory disease of the mesentery charactarized by sclerosing fibrosis, fat necrosis and lipid laden macrophages.

It commonly affect males in their fifth decade, the inflammatory process usually involve the mesentery of small bowel at the base, but never invade the bowel itself, it may cause bowel obstruction or impede venous and lympathic drainage from the bowel due to retraction of fibrotic strands surrounding these vessels.

Clinically in more than 50% of patients a mass is palpable, on CT scans a fatty mass with well marked borders seperating it from normal mesentery is seen, fat ring sign is also charactaristic which is caused by enhanced fat surrounding blood vessels (see fig above), Laboratory investigations may show high ESR and CRP.

Definitive diagnosis requires biopsy to differentiate this condition from peritoneal carcinomatosis and other inflammatory conditions of the peritoneum. Open / Comment

2022-08-31 19:00:32 Triple assessment of breast symptoms include

Clinical history and examination.

Radiological investigations including mammography and ultrasound.

Histologic and cytologic investigation including corecut biopsy and FNAC.

The positive predictive value exceed 99.9%. Open / Comment

2022-08-30 10:07:06 Open / Comment

2022-08-29 19:53:25 Open / Comment

2022-08-28 13:00:32 Cameron lesions

Cameron lesions are linear gastric erosions seen in those with hiatus hernia.

These lesions appear as gastric mucosal erosions or ulcers that usually take a linear pattern and are present at the area where the stomach is extrinsically compressed by the diaphragmatic hiatus (or basically at the neck of hernial sac).

Cameron lesions are thought to stem from a mechanical injury, where the stomach is compressed by the diaphragm as it passes to the chest cavity.

They can be a cause of iron defeciency anemia in patients with hiatus hernia, but because hiatus hernia is very common in the population, iron defeciency anemia with occult blood may stem from a more sinister cause such as colorectal cancer so never overlook these possibilities even when cameron lesions or reflux esophagitis is seen on endoscopy.

Above fig shows cameron lesions at the neck of hiatal hernial sac (black arrows). Open / Comment

2022-08-24 22:38:59 Question

23 year old pregnant female patient presents with right lower quadrant abdominal pain since 24 hours, the patient is suspected of having appendicitis, clinical data includes Rt lower quadrant tenderness, slight fever, nausea and vomitting.

Q1: If an ultrasound scan was equivocal, which imaging technique you would like to consider for confirming a preoperative diagnosis in this patient?.

Q2: What is the best body position to help visualizing the appendix during an ultrasound scan?.

Q3: What are the obstetric complications of appendicitis? Open / Comment

2022-08-18 05:45:32 Open / Comment

2022-08-14 20:04:19 Sabiston textbook of surgery 20th edition.

Highly recommended textbook for postgraduate studies, simple and precise language for better understanding of surgical science. Open / Comment

2022-08-14 18:23:33 Open / Comment

2022-08-14 17:09:02 Note

The acidotic state caused by Inadequate tissue perfusion in the shocked patient was found experimentally to be a some what desirable state, as acidosis helps oxygen offloading from hemoglobin providing better oxygen delivary, also in ex vivo experiments cells were found to better tolarate acidosis than alkalosis, with that being said, sodium bicarbonate therapy in shocked patients to offset acidosis is not effective, as it can worsen intracellular acidosis by increased Co2 diffusion into the cells which is produced by the buffering process. Open / Comment