International surgical boards

2022-04-26 22:13:50 Mechanism of shock

Blood volume is normally roughly 5 L in a normal adult, and capacitance of blood vessels is nearly 5 L under normal conditions, the same amount of blood i.e 5 L is being pumped by the resting heart every minute, shock occur due to discrepancy between volume and capacity or due to pump failure.

Shock can occur because of volume loss i.e hypovolemic shock such as in hemorrhage, large burns, or some skin condition like exfoliative dermatitis.

Shock may also occur because of increased vascular capacity, this is called distributive shock which includes septic, anaphylactic and neurogenic shock whereby blood vessels abnormally dilate causing pooling of blood in periphery.

Another mechanism is pump failure, this may be due to intrinsic fault in heart muscles like a massive myocardial infarction (cardiogenic shock), or obstruction to venous return and/or cardiac output as in cardiac temponade, this is called obstructive shock, the above video shows a patient with cardiac temponade. Open / Comment

2022-04-26 00:52:18 Introduction to shock

Shock is defined as a clinicopathological syndrome caused by Inadequate tissue perfusion.

The state of hypoperfusion creates imbalance between oxygen and substrate delivary and their demands by tissues, the eventual result is cellular injury.

Cellular injury itself incite an inflammatory response which furthur worsens the state of hypoperfusion via their structural and functional effect on the microvasculature which will be discussed into more details in the upcoming posts.

For this reason a vicious circle is created in which hypoperfusion causes cellular injury and that itself leads to more hypoperfusion with the end result of lethal irreversible cell damage.

Therefore the aspects of management will focus on recognition of clinical shock and timely intervention to avoid irreversible organ damage, clinical shock is usually defined as mean arterial blood pressure of less than 60 mmHg in a previously normotensive person. Open / Comment

2022-04-25 01:49:23 Bailey & Love's Notes pinned «Announcement In the following posts we will be discussing critical care and approach to a patient with shock, this will include detailed discussion about : 1) Pathogenesis and organ response to shock. 2) special forms of shock and their management including…» Open / Comment

2022-04-25 00:28:50 Announcement

In the following posts we will be discussing critical care and approach to a patient with shock, this will include detailed discussion about :

1) Pathogenesis and organ response to shock.
2) special forms of shock and their management including :
Hypovolemic shock.
Traumatic shock.
Intrinsic cardiogenic shock.
Compressive or "obstructive" cardiogenic shock.
Septic shock.
Neurogenic shock.
Hypoadrenal shock. Open / Comment

2022-04-25 00:19:01 Emphysematous cholecystitis

This may follow non-gaseous cholecystitis both calculous and acalculous cholecystitis, it is most common in elderly men and in those with diabetes mellitus.

This condition begins with ischaemia and gangrene of the cholecystic tissue followed by an infection by a gas forming organism especially clostridium welchii and clostridium perfringens, or in some cases also E.coli.

The condition is clinically indistinguishable from non-gaseous cholecystitis and can be diagnosed on the basis of finding gas within the gallbladder lumen and gallbladder wall such as demonstrated in the figure above.

Mortality rate is considerable and treatment is by prompt surgical intervention coupled with appropriate antibiotic therapy. Open / Comment

2022-04-23 23:09:22 Open / Comment

2022-04-23 23:07:13 Griffiths and Sudek's points

These are watershed areas within the intestine that are located between two areas of different vascular supplies.

Griffiths point is at the splenic flexure and marks the area between the territory of the superior mesentric and inferior mesentric arteries, Sudek's point is the sigmoid colon and marks the area between the territory of inferior mesentric and internal iliac arteries (see figure above).

The clinical relevance of Griffiths and Sudek's points is their greatest susceptibility to ischemic injury in the event of mesentric vascular insufficiency. Open / Comment

2022-04-22 22:29:35 Abu al Qasim Al zahrawi, also known as the Father of surgery, born 936 and died 1013 (Lived in Andalus during the islamic golden age), has countless inventions and discoveries in cataract surgery, laryngotomy and many more, he was the first to describe the hereditary nature of hemophilia, Al-Zahrawi also pioneered neurosurgery and neurological diagnosis. He is known to have performed surgical treatments of head injuries , skull fractures, spinal injuries, hydrocephaly , subdural effusions and headache. The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children, he was also a leader in chemisty and internal medicine, He also pioneered the use of catgut for internal stitches, and his surgical instruments are still used today to treat people. Open / Comment

2022-04-22 02:22:45 Note

Globus pharyngeus is a sensation of a constant lump in the throat but no difficulty in swallowing, occurs especially in indivisuals with emotional disorders particularly women, results of barium studies and manometry are normal, treatment is mainly reassurance, some cases are associated with reflux esophagitis and may respond to the treatment of esophagitis.

Source : Harrison 16th edition. Open / Comment

2022-04-19 00:43:06 Share with us your favourite surgical speciality Open / Comment