Surgery videos & books

2022-04-01 13:49:42 49)A patient is operated on with the presumptive diagnosis of acute appendicitis. However, at operation, the appendix and cecum are found to be normal. The terminal ileum though is red, edematous, and thickened with creeping of the mesenteric fat onto the… Open / Comment

2022-04-01 13:48:43 49)A patient is operated on with the presumptive diagnosis of acute appendicitis. However, at operation, the appendix and cecum are found to be normal. The terminal ileum though is red, edematous, and thickened with creeping of the mesenteric fat onto the ileum for a distance of approximately 30 cm. There is no dilation of the bowel proximal to the area of inflammation. The remainder of the small bowel is normal. What is the appropriate operative procedure? Open / Comment

2022-03-27 18:55:05 In a patient who is known to have had symptoms of peptic ulcer disease for many years and presents with nausea and vomiting, one should consider gastric outlet obstruction. The obstruction can be the result of an exacerbation of the ulcer and subsequent edema or it can be secondary to scar tissue formation. These patients typically describe the sensation of epigastric fullness and demonstrate visible peristalsis going from left to right. A succussion splash may be audible. The history of periodicity and pain relief by taking antacids also favors a diagnosis of previous peptic ulcer disease. Patients with an umbilical hernia will have a mass in the region of the umbilicus. Patients with acute cholecystitis usually present with the sudden onset of pain, radiating to the back, with fever and chills. Volvulus of the sigmoid colon presents with constipation and abdominal distention but vomiting is a late feature. Small bowel obstruction would be associated with a history of colicky abdominal pain, nausea, and vomiting. Additionally, patients with small bowel obstruction usually have hyperactive highpitched bowel sounds on examination. (Townsend et al., 2004, pp. 1283–1284, 1295) With persistent vomiting, the patient becomes dehydrated and hypovolemic. Loss of hydrogen ions, potassium, and chloride in the vomited gastric contents leads to alkalosis, hypokalemia, and hypochloremia. In response to the hypovolemia, adrenocortical and renal mechanisms are stimulated to conserve sodium at the expense of potassium and hydrogen ions. Excretion of potassium in the urine further aggravates the hypokalemia. The kidneys then compensate by exchanging hydrogen ions for potassium, which results in a paradoxical aciduria and self-perpetuating metabolic alkalosis. Open / Comment

2022-03-26 18:54:03 48) A 50-year-old man comes to the emergency room (ER) with a history of vomiting of 3 days’ duration. His past history reveals that for approximately 20 years he has been experiencing epigastric pain that lasts for 2–3 weeks during spring and autumn. He remembers… Open / Comment

2022-03-26 18:52:24 48) A 50-year-old man comes to the emergency room (ER) with a history of vomiting of 3 days’ duration. His past history reveals that for approximately 20 years he has been experiencing epigastric pain that lasts for 2–3 weeks during spring and autumn. He remembers getting relief from pain by taking milk and antacids. Physical examination showed a fullness in the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel sounds. What is the most likely diagnosis? Open / Comment

2022-03-22 11:37:01 Contraction of hollow organs against obstruction or excessive contraction causes colic. Typical ureteral colic is severe, sudden in onset, radiates from the loin to the groin, and is associated with an urge to urinate. Blood clots and calculi in the ureter can cause colic, the latter being more common. Urine examination demonstrates macroscopic or microscopic hematuria. Open / Comment

2022-03-22 11:37:01 Contraction of hollow organs against obstruction or excessive contraction causes colic. Typical ureteral colic is severe, sudden in onset, radiates from the loin to the groin, and is associated with an urge to urinate. Blood clots and calculi in the ureter can cause colic, the latter being more common. Urine examination demonstrates macroscopic or microscopic hematuria. Open / Comment

2022-03-21 11:36:04 47) A 38-year-old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to the groin and associated with nausea, perspiration, and frequent urination. He is restless, tossing in bed, but has no abnormal findings.… Open / Comment

2022-03-21 11:35:05 47) A 38-year-old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to the groin and associated with nausea, perspiration, and frequent urination. He is restless, tossing in bed, but has no abnormal findings. The most likely diagnosis is which of the following? Open / Comment

2022-03-14 07:20:01 During total thyroidectomy, parathyroid glands may inadvertently be removed or their vascular supply interrupted. Hypoparathyroidism may then develop, the manifestations of which include tingling, muscle cramps, convulsions, and a positive Chvostek’s sign (contraction of facial muscles after tapping the facial nerve). These symptoms are dramatically relieved by intravenous administration of calcium. Oral calcium and vitamin D are administered for long-term correction of hypocalcemia. Open / Comment