surgitoons part 3 special surgery

7/29/2019 Surgitoons Part 3 Special Surgery

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HOWTO IJSET}IIS BOOKTk B*k, a daEndb CqW 'C*gW" and Molcr traruting a triloull, be,.Ead, branl u und ,*fpd tnto {ru,, ,{hfk, algo,tilro,t *d drgr^t b Mo*o

tr ortt fu g*b rytrusto ulroh bwdo in o watu ,{ lrw!Tfio,ol a buulo ,{ Cpeml All,-ou {r{ln*g pnda bwda nfla boolo, ululo

ui,U ,rrako go,n tttfu ilrirenbfiota/,get ..

TWEET W 6EBNAT,rtefi of ln{o,w,oto"frotgow uag tiltlt fuing fufuug Aob,ura/+, Ahng u&,tow irqata$poofr frr"to lfiCQt

AA frgilrrh i* o auph ,{ poput!!

KEYC TO CACEC6,nl to tdu ol upafot$ Cliraul cata, ulatgou platfll

uu/tc h4N atout?n/t uto iro o {eil uoqA

QUECTIOI/ BANKQUt u {,rr* p,,uarrl erurrl attwgd ad cafrgaizd

auddtug bto u$ufb gi@ lotr on arurab ttatutnbdnin gow alfrfiffi b f,o upotafi d *pfu qutou.

TAKE YOUP NOTEClfgr* fnd bto dra uhuatu,* ueAl,0, *! Addtr"rtrru!!


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ORTHOPEDICS. Oenoml schsno. frcalmenl & Complioefions ol Fracfures. Uppor thb. Lmr Lfunb. Bone Defiomrilies. Bone inf,srnmglions. Bonc furnoE. fwe,is, Cesee, Queetlon Benk, ilotosUROSURGERY. fumo[t. lnjurloe. lnf,anrmslionsr ebrres. Obslruolh/r Umpathg. Cor{Fnital anomalee. Teslis. Iweele, Cs.6, Queclim Bark, I{ologNEUROSURGERY. Heed injuries. Periphoral llowe inJurirr. OiC9. 0ku[ ]romstome. fumorc. heolurc spine, &ein abscess. Spine biftde,

Dlec Prohpee, Cqwrhous dnus lh. fursel$, Cesss. Qusfiotr Bank, iloilee

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2sIv2t;26gt3842475tBI6{)BI68,68288969799I(x'

PIASTIC gURGERY. Bulhs. 8&in closurc. 8kin. 8C lesions. go0 {lssue sarcoma. Aeslho{lc surlgorg,Bed sores. Ptgmenled skin lecions. Non-Melanotic skh fumors. fo4gue Ulcers. Cancer lotgpe. &mlhq6rs of the jaw. Clsh hp, Clef, palaile. Miece[arreous lopics. Iurests. Casec, Queslion Bank, llolesCARDIOTHORACIC SURGERY. Carfrac ansst. Fmcturee ilbs. hsrmolhorex, Hernolhomx. Empgenra. Posl-operetive pulmonarg compftcalions. Tweets, Casec, Queelion Bar*, llolesPEDIATRIC SUROERY

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ilR4-1oq'15. )rlnopedk, aury\ ?I,QY t t

Sne n{CuenldeTRAO'NIA DIRECT,!NDIRECT

SfiPrilisO Historg of lraumaO PainO SwellingO Disturbance Of

funclion (inabilitg touse lhe affected limb)O Specific sgmptomsaccordinp to fraclure

ShockFal embolismComplicalions ofProlongedrecumbencglnfection, crush $

INvESNqAflONS

. Skin . Bloodvessels, Visceral . Nerveinjurg injurg

. Joinls . Bones

POSITION OF DISTAL FRAGMENIIN RETATION IO PROXIMAL ONE.

GENERALO HemorrhageO ShockO Associaled injurg

O ReduclionO FixalionO RehabililalionO TTT of complicaiions

LOCAL

TendernessCrepilusTemperalure(in

Neurovascularevalualion :Vessels ,Nerves

t.l(,o.Ms&

Tendons

X ras 3 i"'#:";"H::':iJJ"J""DefinitiveBCD Resuscilation


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RED',CTPN

Fnl}IAnl/ SecoXpan*f

6.oseo

SSoR\rEtl SoR\rEy

OFEl.l

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r{oN-nGp+tAstEROF PAFIS

Open fraclures (Cornpound) isbesl lrealed bg Open reduclion& Exlernal Skeletal fixalion

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rnAcrtoN

lzAiloN)

-mGp/-)'+el


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,tfr PRIMARY SURVEY: ABCDE .... Airwag, brea*hing, circulalion, Drugs, exposureSECONDARY SURVEY : Head lo loe Exarn, AMFILE Hislorg , lnvesl'rgaiions (AngREDOCf,IoN oFTl,lE rnActt RE,

Pulse relurnsDEAL WITH THE FRACIURE

lrr'rgale wilh saline &Wound debridmenlSkin) Excision of l-2cmFascia) Open lense fasciaMS.) Excision of dead Ms.Nerve) Mark wilh black silkBlood vessel ) Deal asClosed injurg with lear...

trtrtrtrtr

OPED.I

WAIT for 20 rninutes

t{rt{ourrEARSPASIrl

IPainting Orlnlra-arlerialpapaverine

No pulseEXPLORE & DEAL

CotfntstoNI

Excision of theconiused

segmeni andsaphenous graft

Ch.oGED

--r-1


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ffi OF PERITI{ERAt NBq'E IIMClosed injurgMNeuropraxiaMAxonlemesis

I+MSplintageMExercise & MassageM EleclrotherapgM Proteclion of Skin

@MNeurontemesis

(lf injurg occursduring operalion)

MOpen injurg or Closedwith failure of recovergMPalpable Neuroma,Tinnel's sign

5UP$.-T1Arr.

lrnproRecove

MArlhroMTendMAmp

/ Approximale 2 ends of N. bg blacksilk sulure3-4 weeks laler:/ 2 ends are cui & Exposed & Trirnrned,/ Apposition of Nerve shealh/ Repair (Epi-neural, lnierfascicular )

IAt lime of Wound repair:MNeM Di

brMTrMNe(SM Fi

we


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OFMORBIDITY MORIALITYGENERAL' Shock, Embolisrn. lnfection. Crush $. Due toProlongedrecumbencg

LOCAL. Skin. Muscles& tendons. Blood vessels. Nerve injurg. Bones. Joints

1,R{4-jI0U.1r. )r


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MYOGTOBIN-URIA

CRUSH INJURY,COMPARIEMENIAL $

TREAIMENI:M As ang Polglrauma ...M TTT. of lhe causeM Forced alkaline diuresis- Fluid- Manniiol- Vitamin K/

VgVDeposilion of Ca*2 in sofl lissues lhal lnvolves )Bone, Periosleum, Laceraled MuscleAfter ELBOW INJURYMechanism:

\

. Ms. Laceralion)

- Fluid- Mant- Vilan

hemaloma) lransformed inlo bone. Massage & passive slrelching of joints) Traumalic ossiffcans

ACREATININEIN BTOOD

EI Trealmenl:l) Prophglaclic)earlg reduclion of fraclures & avoid Massage2) Active) lmmobilizalion & reseclion afler 6 monlhs

5UPt+-Tw,t .)r

Osleoblasl invade

M Marked osleoporosis & lhickdue lo disuse atrophg or Sa

ggggColle's fraclure, foll's fraClinical piclure :

Neurolic female) pain, sweX-rag ) Palchg osleoporosifrealmenl :E Prophglactic ) Exerci!l Aclive ) Hol wax, ana

MM Siles: fltlE. EEMOML HEAD > after. CARPAL SCAPHOID. CARPAL LUNATE. TALUS ) dislocalion, fracV X-ru1 > NORMAL earlg, appM TTI : acc. fo sile:l) Femoral head ) Auslin m2)Scaphoid ischemic Necros


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CoMruCtnlmpairmenl of circulation 2rg to APressure >3OmmHgETIOLOGY:. { size of comparlment' 4 ConlenlsSIIES:

gg

a) 4 compariments of Leg: Ant, Lal, Superf, deep posleriorb) Forearm )Volar , dorsal comp.c) Hand ) lntrinsic compartmenl ....lhenar, hgpothenar ,inlerossi, [umbricals )CLINICAT PICTURE :tr SEITERE pain on PAgglVE exlension of di$tsE Abseni pulse

COMPTICAIIONS:E Generd) Crush sgndromeEtr Local) Gangrene, Volkman's ischemio oonlractureIREATMENT:7/ Prophglaxis) Avoid tight casts/ Aclnte) Decompression bgfasciolomg & debridemenl

ARq--TWrr

gg Flexion conlracture due to {ibCTINICAL PICTURE :l) lnabililg to fullg extend2) Fixed lenglh phenomeno3) Extension of meiacarpo4) Complete Claw hand5) Weak hand gripIREAIMENI :,r' Porphglactic ) Rapid rassessmenl o{ vascular/ Aclive:a) Earlg


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plGDue lo Due loPresence of GAP Loss of blood supplg

CLINICAL PICIURE:. Pain, swelling, dislurbance of funclion(persislenl tenderness, abnormal rangeof mobilitg)

INVESTIGAIIONS:' BONE $CAN: 4 Uptake in HgperlrophictgPe

TREATMENT:' Hgperlrophic) Rigid fixalion. Alrophic) Bone Grafl & Fixalion

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ETIOLOGY:. LOCAL: lnadequale Blood supplg,lnfeclion, Foreign bodg, Tgpe ofbone. GENEML: Age, Nulriiion, sgslemicillness, Drugs (Corlicosteroids). ORIHOPEDIC: lmproper reduclion,lmproper irnrnobilizalion

CLINICAT PICTURE:. Pain. Swelling. Dislurbance of funclionINVESTIGAT!ON8:. BONE X-MY:

-p12stur",IEIEIGIE

ET..TY

CL

CO

TR,TREATMENT:. TTT. of lhe cause. Bone Fixation


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5)Pq-10U\r.)rfno7ed'ic, surd?\ ?[,hY t tt

Site Junction bet medial %3 & laleral l/3lncidence IrllTrauma Fall on oulslrelched hand , Blow to clavicle

Displacemenl MEDIAL FMGMENT: Pulled up bg sternomasloidLATEMT [f,AGMENT: Placed downwards bg weighl of the limb,t t*tq;0 OSgrnplorns As Genera! Scheme ...

ct)L.Epcl)

lnspeclion As Genera! Scheme+

Palpation Broken displaced clavicleMovemenl

Neurovascularbundle o )GpO , Tl) ) Claw hand + loss ofsensalion of medial side of forearm * medial ?Yz fin$ers

Complications As Scheme + ...* Mosl common:* Rare ) Non-union ,Sfiffness, lniuru of NVBlnvesligalions X.RAY:LoEoo

ABCD * ResuscilationDefinitive fr lmmobilizalion + Follow up o{ radial pulsetr Child ) Figure of I Bandagetr Adult ) Arm to Neck slinq

Cornplications n ORIF if Non-union, NVB iniurg , Pleural iniuru


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HUffirO" Most common ioint dislocaled in boduO Cornmon in Adolescents & Uoung adulisMORE COMMON INCIDENCE

Forcible abduction &rotalion TNAUMA Forcible abduclion &rolalionMosl common displacemenl) CEMENT Sub-acromial, Sub-spinousAs scheme... 'YMP S

As scherne...oOPl. holds injured limb al elbow bgother hand, with uprightOUpper limb is apDarenllu shorter viE(fralrcpection

Head is oaloable anferiorluCOMPETE TIMITATION Movemenl

Axillaru ARIERY (6PsltuyE

.Fracture Grealer luberositg.Roialor Cuff lear ) inabilitg toabducl armCOMPLICAT/oNS

' - Due lo Bankart lesion- ITI : Bankart's ODeralionX-RAY:. A-P view )confirm dislocalion. Lateral View ) Anlerior dislocation,rt yEsrr6qrroils

ABCD + RESUSCIIATION

=uEurE

Defiditive ABCD + RESUSCIIAIION$t Reduction under G.A. )Kocher's Methodl) Outward iracfion2) Exlernal rotalion3) lnlernal rolalion &

adductionfr lmmobilization (adduction, IntRotation)!)l Rehabililation

$t Reduciion:l) Adduction2) External rolalion

Axillarg arterg, NerveFracture Grealer tuberositgRolalor Cuff tearRecurrence

ffT-oFComplicution* a


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5u?14.j{i0q.15. )r&ayad,ic,lur6Qr\ ?lQ7 t t+

\,o Direcl lraurna lo elbowUlna migrates +fraclure of

Trealrnent:N ORIF

Fall onoulstrelched hand O Ulna migratesO Fraclure of

freatrnenl:tr Reduclion under GA)Downwards &forwards traclionfr Fixalion with elbow casl for 3 weeks

!1 Exercise for 3 weeks

. lnferior Radio-ulnar jointdislocalion

TTT:OPEN REDUCTION,INTERNAT FIXATION

Comrnon in adolescents & ElderlgTtI

Painful Pronalion &TTI ) ORIF or excision

of forearrn


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lJP$-:l?Arr.lrlhopadtc, surbQ\ ?lQY r WI inch above dislal

end of RadiusPostero-lat. Shifl& Tilt of dislalfraomenl

Exlra-arlicular fraclure, I inch above distal end of RadiusFall on lhe Dalm of outstrelched hand

Posfero-laleral shift & fi[ of Lower segmenl 4tt )* dtzuAs scheme ....

Loss of aclive movement, Painful passive movemenlis affecled (Iested bg )O Median Nerve injurg ) Ape hand + sensoru loss * lesls (counting

Campllwtlons MAI-UNlON, Carpal lunnel $, Sudek's atrophgdeformilg= Ulnargrowlh > radial growthlnvestlgatlons X-RAY:// A-P VIEW: Lateral shiftz/ LAIEMT VIEW: Poslerior shift of distal fragment:: To Differenliate fiom Smilh fraclure ::

ABCD, FesuscifaffonDefinltlve tr Closed Reduclion & Fixalion bg Cast for 4-6 weeksl) fraction of hand2) Counler lraclion of humerus3) Push dislal fragment )Anleriorlg & Mediallg4) Cast is below elbow except if associaled with Fraclure ulna(above elbow)

tr Rehabililafionfr N. injurg , Arterg injutgB Sudek's afrophg ) Sgmpathectomg, splinting, analgesics. PhgsioE Runlure of lendon ) Transfer of tendonEl TRAIIMA: Fall ontrtr is Shiftedista!IE:tr DIAGNOSIS: X-rag laleralview to differentiale frorn

Colle's fracturetr TREATMENI: Reduction & fixalion bg above elbow casl for 6 weeks


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ilEq-T1qr, )rlhoTed'ic,aury\ ?lQ7 t tt"ffiwlDpNeSite Waist of scaphoidl*ideme

Traumo Fallinq on oulslrelched handD/lrprorca;ranaSWfiotrs As scherne* ...

Pain in wrisl , Palient can move his hand (no (ross imDairemenl)uaa

lnswtkn As scheme+ ...olfutioaMovementilwCanrplkofiorn,s m of proximalfraemenlhwestigotions: X-rau: ITffiEfiEEItrElG

ca,EEJtr

M6Eesuscitor;baDrftrttive E Plasler of Paris for 6 weeks ) Below elbow*abducted thurnbE lnlernal fixation wilh Herbert's screw

Conplkotlons fr Bone Arafl for necrosisFRAC'IURE SSlUIFT OU{IE RADIOSE Most common Complication istr III: Fasciotomg

, (oFOFROOESS OF RADIOStr TTT: Colle's Cast for 6 weeks

BAF{rOD{,S FRrc']T'FELE lnlra-articular fracture of RadiusBENNEt'S FRAC'IUREEl Fracture dislocalion of l8t melacarpal


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F>M , rl Childol'gohgdraminss ,i 6 riili l.gglli s3g breech iUjU EJJI ti16!! ii I ! l;Palhologg : Hgpoplasia of Hip joint}GONATES

IPPTSga timilalion of abduclion in {lexionDifficultg in applging Napkins

f Gilor.qltil fEAnrotrrlt===Fr ==ii:=E===iOn lrial lo reducehip, a CLUNK isheardIx s Jdl ui ote ou\b*

ulyr ull\ Jc thumb 0\Hip ll o[e a\udl e \* oo

.... Abduslion rhri saqcaNri DDH slis d

ord\ osil1liJ\ebisi

g Delaged walking.M Asgmmeirical gluleal creasesGaiftM lf Unilateral ) Trendlenberg's Gail er+tlM lf bilateral ) Waddling gair.unir+{

5RI+'T0qr5. l

Ihe hip subluxesoul of theacelabulum) ACTUNK is heard... ,;ili Jl irrrJ\.rlolusl s trrltsal,>ill dimrihDlio nucaN\b q

o$l\ ounrLJ\

ffi&ADag LimitaAsgm

g NEWsponllill 3faileROSE6 MoPlaslabdu>6 g

gg


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fficForcible abduction & ExlernalRotalion of flexed hioAt Obiurator foramen

tLimb is anoarenllu

As Scheme...

Head mag be fellLoss of aclive & Passive@EE@Wlnjurg of Fernoral& obturator NVB

IilEil

TraurnaDisolffieillentSvrndornr

PD

As 8cheme...

r x-rau ) A-P + lateral. Cf scan

lngpsctlon

Forcible flexion * adduction *lnlernal roDash board accidenf, Fall of heaw obiecl on back of

6ag|UI

il?$-:lC[hl, Orll

Palpatlon

B Reduclion (as Post)R Skin lraclion for 3 weeks bgIIffi'TI

il@ernentNeurouarcuLrbundle

FEMORAT HEAD tg FEII, EEEIE@I (DtFFrculry roPUTSE DUE TO BACKWARD DISPLACEMENI OF FEMO

Complicadons

LL isPain, swellinq. inabilitu lo walk or slan

lnvertlgndons:

Ecialic or ischial

E@qII* Molor )Foot drop* Sensorg )Back of fhighasDecl

cItcaLF

General ) Shock , Prolonged recumbencgLocal ) Ecialic N. injurg , Avascular neuosis, irresliffness

Loss of aclive & Passive

a

Definitive

I@ ' ii}|J e .igsJ iidu, lum, associat6tkffi ctures & Fem

Alter careCompllcatons

fr Closed Reduction bg [@(lf failed or associaled fraclures ) ORIlmmobilization for 6 weeks1

+ Leg, fool

ABCD & Resuscilalion

Neurolopical assessment . earlu molion. Followm Sciatic N. iniuru


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NEEKi,g;frrl ii.otniiirrans- Basdl M

lncornplelefraclure

ITR.EAIMENI:Resl in bed

A,Rq''TC[f'lr. )r&

TREATMENT: A/ASCO[.{R,lnlernal fixalion N*O$Sbg Moore Pins According To Age,+\Old young!*TREATMENI: onre! ous

Trochanteric

HEMI-ARTHROPTASWIhompson , Auslin moore


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/ No Rolalion/ Limb appears to be abductedoqijl r,r,!ri gfu1 r iii a [6J lcr.a ii

Mlloilarr.lIN IHE ISI S MONIHS

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/ DW, P.E/ Osteoprosis/ Constipalion... lnleslinal obstruclionPROTONGED RECUMBENCY

qEl.lRAtiioRElDrF/

ffT: Conservative ... Rgle, Line,Catheter,Fluids, moniioring, Decompression of Colon

Neurovascularbundle

IM:O EUI@

A-P with internalr-4g+uU

INrTRA_CAI>/ Mal-unionrocAt

/ NVB//


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ffiFEhNDisplace-menl

SleProx. Segmenl

Sgmploms

oo0cl,

Dislal Segmenl

n

UENERAL

Scm below inlerlrochanleric line

LOCAT

ComplicationsAs Scherne * ...

Abduction & Fixation (Glulei)Adduction & Uowards (lleo-nsoas)

*.r TNSPECTION: Ecchgmosis, Bruises, swellingPALPATION: fenderness , eepilusMOVEMENT: DiminishedNEUROVASCUIAR BUNDLE: Femoral arlerg

*

lnveslipations :

*

oEoo3-F

De{inilive

5UP4|-T00N5. O

Ir[i

oooooo

Forward (quadriceps)

Prolonged recumbencgNVBMgossitis ossificansSliffness of KNEE

Complicalions

tn belweenBackwards lHamstrinol

As Scheme...

ORIF &lnlerlocking nail

in Midshaft, Popliteal arlerg and n

ABCD & Resusci{alion;i[Lll r,rnrr;-lt!1 Newborn) Crede's method tsHJ [tk!!i lnfant) Gallow's iracfion!R Child) Reduclion & fixalion bg fhomassplint9l Adult) ORIF& lnferlockino Nail

X-tett

Mal-union , Non-union, lnfections


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m/sEFINIIION: Fraclure lower end of

TMNSVEREEAVUISION OF[fifitltrMAHFSIil{f +DISPIICEMENI

tibia& {ibula involving the ankle ioint'Jr =:\\

t- + ...oBUOUE AVULSTONOFEEIEITE'tffiffi *DIBPI.ACEMENT OFIAIUg

oBrcFuffiffiiloNMAr#F$filts +

DISPTACEMENT OFIALUS

TREANIE}.TTlf Polg-lraumalized) ABCD, R&MFIRST AtD) Trial of reduction for displaced fractureeDefinitive TTT:- lf Slable ) Below knee plasler casl for 6 weeks- lf Unstable )ORIF bg Screw lur-i [5J;lor.,n


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pNeCongenilal (Vertical Talius), i

TTI : soft lissue- wedge Tarsectorng

O TTT: excision of Base of Proximal phalgnx

vALqOi.n(r


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ilP{4-jtC[/,\r. )rlhoyad,ic, surbQ\ ?l{+ 1 U


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ilRq

t+ "1" Jr+.lor! e1 c.F,_*- dt J*- py- Jf r,ltGlr oitU a,Jl... eJl .:" C-. :-,- ;jhyt e:t :" -4s

k lc j95to 4jl JGi,i9 Gi,iuJl. Bone Sclerosis & abscess cavilg

Rest, analgesics,aniipgreiics, anlibioticslndicalions:. Failed Medical TTT.> 48 hours. Lale presentalion. Abscess. Drainage of subperiosleal abscess

Afler 48 hoursDecide conlinuiluof medical TTT.According loimDrovement

Anlibiolics for4-6 weeks

I I

j Trealrnenli tt Saucerizalioni ,l Sequeslrectomgi zr Sinusectomui / Bone Grafl . Trealmenl: Saucerizalion &


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,( lncidence :/ Eliologg:O Organism : Staph, strept. +O PDF : General (Sepfic focus , low immunilg) , Local (frauma )O Roule:. Blood

5UP4'TW'lr. )rfnoTadb rvryz\ ?r,q9 t 10

. Direct: Penetralint trauma/ Clinical piclure :

// Diagnosis :o Laboralorg: 4ItC, 4ESR, CRPo X-rag: Sofl tissue shadow + VJf. SpaceO U/S: Effusionz/ Treafmenl(ll'sa ):B General: Rest, analgesics, antipgretics, anliblol'rcsE Local:l) Washout o{ infecled joint2) If eroded Cafiilage ) Arlhrolomg & fraclion3) lf Complelelg separaled Cafiilage ) Arlhrodesis

I

O SwellingO Dislurbance offunclionO lnspeclion: 9wellingO Palpalion: Hotness, TendernessO Movemenl:

ffiSTTESrcRTB/ Lhant, / ii.obtt, / 11[fu:Hlplolnt, VerAebrae Spine


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5'Pt4\\

ETIOLOGY:ORGANI$M:

MgcobacleriumTuberculosis

ROUIE:2RY BLOOD BORNEFROM LUNG TBPDF:lmmuno-suppression

chrNtcAl-PlcrrrneGENERAL) TB ToxerniaClinical piclure of Primarg Focus (e"g.

PATHOTOGY:SITE:. MOST COMMON SITEIg DORSO-LUMBAR

SPINE. AFFECIS ADJACENTPARTS OF THE BODIESOF VERTEBME WITHTHEIR DISCS

MACROSCOPIC:. Verlebral bodg isdeslroged, replacedbg casseous malerial. Deslruclion of disc. Collapse of lheveriebrae

MICROSCOPIC:TUBERCLES:l- Epilhelo2- Giant ce3- Surroun

Lgmpho& Fibro

&* CI Scan, MRIX-rag:l) EarlgOsleoprosis2) Destruction ofvertebral bodies3) Arnalgamaledintervertebraldiscs4) Kgphosis


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CoMrutcffiol.ls oF Furr' s DAbscess collecls under anl. Long.Ligamenl infronl of verlebral bodg

IItCervical region )RelrophargngealThoracic region)Passes lnlercostal spaces& Out from Laleral or medial perforalorLumbar ) Psoas abscess

*** R,EVERSIBIE

5URfl-100N5.)rt

OFFOIt'SOISE** SanalorialAnli-luberculous for 9 months:O Rifampicin + INH +Ethambutolfor 2 monlhsO Rifampicin + INHfor the resl of course

le

** Aspiralion bg Z-lechOpen drainage :l) Chest) Coslo-lransverseclomg2) Abdomen) Anterior approach


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Er{effiOnlRq--fC0), l

Corrunur is!s! of Bone :

* Osleoclaslorna(Giant cell tumor)

* Osieosarcorna* Ewing furnor* Multiple Mgeloma

ttlhst GorunmO ln Clfl&en)oeteosarcornaO ln Adr$s ) MullQle mgelorna


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o ttlas u" singl" or pa* of @f,1[li$!( Der osis )o) ( noc)O X-rag:"Bong projeclion wilh carlilaglinous oapsule"O TTT: ExcisionSite)Pelvis. ribs, proximal long bonesX-rag) Fluffg calcilicalionITT ) Surgerg (Resislant lo radio, & Chemo)

OCenlral lumorOENCHONDROMA OF SHORI BONES OFCHITDREN NEVER IURN MATIGNANI

leq-'Twrr. orl

MefaphgsiHumerusCgsi : filSlraw col


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Incidence & Ageffi ffi.I^ f1 mffrfl, ffl

Sile

(,oJo-Cell of orilinMacroscopicMicrcscopic

tflilitElsAround Knee.... , awag from elbow

2O-4tJ.lemale

Spread

UNKOWN, thou{hl lo be Osieolulicbrown, areas of Hemorrhage , necrosis

clo

Uolnspeclion

Mulli-nuclealed $anl cells

Palpalion

o=9F


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ilRq4Wti )rlhopedic, turffry ?l,hV | 17MtLm-eAge & sex: Mosl commonlg in Old age

..... oroD 1.p C?9 orir jgfr rhltBones wilh hematopoietic BM :O SpineO Skul!O Ribs, slernurnMarrow sDace is replaced bu diffuse Qelalinous Red lissueSheels of olasma cells of malipnanl characlers

WideE Pain " Backache"tr Pathological fraclureE Paraplegiatr Pallor .... Anerniatr Weighf Ioss, infeclionsE Hgpercalcernia... Weakness, faligue,

Clintcatpinwe

l) Normocgtic, normochromic anernia2) mm/l*t hr.3)Monoclonal Garnmopathg4) Hgpercalernia

M Pallialive Chemotherapg "Prednisolone + Malphalan "M Spinal de-compressionM BM lransplanlEI Bisphosphonales ..... for hgpercalcerniaM ITT of anemia

Treatment


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il?14-{0Nr.)rthopeile, iuw\ ?lQV t qeffi'sDwDefinilion:M Avascular Necrosis of Femoral head u.ito guipl

1'ril+l{ rr-il JgJl gl ii l'(rirol! gru ,",.il guiplt n,! t r ..lii,! | 6JJt ii o.! I rr Il #.JJl .-i Ul+ri g #.JJl ,--s GIS ffo rrjirir=pr

Incidence & Etiologg:V 90% UnilaleralM Male Child (5-12 gears) niili JsJrJ-ri us *+ g ul+ilg.litdl,..p piM Recenllg : mag be due lo ihrornbophilia

Pathologg:M Site ) Hip jointM Stages :l) Stage I : r-rgall ischemia, bone dealh2) Stage ll 3 r"rr!ll revascularization & repair3) Slage lll : urli.tl Disiortion & rernodelingclo:V Pain in hip ... referred to kneeM Mag lasl for 4 hrs after inactivilg .. resolve and then relurn at nightM Pain mag be sornelimes in lhe unaffected limb ln,ilr.'l'iitloUllnvesligations:M plain x-rag & aspiralion of abscess (if there's seplic arthritis)Trealrnent:M Most cases (75%) resolve sponlaneouslg within 2 gearsM Non-surgical ) rninimize rnovemenl * fxalion bg abduciion braceM Surgical ) IENOTOMY, OSTEOTOMY


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il84-10\'15. )r&aped,1, lury\ ?lhY I n' Sure signs of fraciure: Deformitg, lengthdiscrepancg, Crepilus, Abnormal movement, fhere is 2 tgpes of open{compound } fraclure:lrg {the lraurna from oulside cut the skin ihenfraclure the bone),2rg {lhe lrauma frorn inside,bone fragmenl causes skin injurg). The main complicalion of open fraclure isINFECTION

e

- Grade l: low energg ,wound lcrn in lenglh- GradeS :h'rgh energg wound with exlensive lissue damage! 3A:Adequale sofl lissue lossn 3B:Extensive sofl tissue loss and bone damagen 3C: Associaled wilh arlerial injurg' Shoulder joint is the rnosl common joint in the bodg lo be dislocaled due to:l-Shallowglenoidcavitg & large head of humerus. 2-wide range of mobilitg 3-lax capsule &weak ligamenl. fhe commonest fraclure of lhe scapula involve the neck or the bodg of lhe bone' Fraclure surgical neck humerus usuallg occur in elderlg palienl associaled wilh osteoporosisand ils most imporlanl complicalion is axillarg nerve injurg. Blood supplg of femur head &neck:I- Exircapsular arlerial ring2- Relinacular arlelg3- Arterg of ligamenlurn teres4- Nutrilional arlerg. One of lhe mosl imporlanl complications of fraclure both leg bones is compartmenial sgndrome


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il?+'T1qrr. lrfrapedic, rury\ ?hh9 t *0


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SURGI-

bhae/


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5UP4-10q:\r. Uro' eurgzry ?lQV t +L

URIWTRACI. REIIALTUI,IORS

TUTIIORS

;:l [irt;1"Did you srvitch nry apple juice tvith a urine sarnple again?


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cilRq4W:rr. Uro- turyery VhY 1 +1PR$ilAFT' PAFEhICLIIhiAL REhIALTUWIONSlilr,v,ISEiII^ fTg/E-nEfliY.X^llff-{a,Clncidence &Palhologg r

,lO7o ol Childhood malignancg (3-4 gears). Carried on Chromosome ll. 80% Differentiated

Mosl common lumor of Renalparenchgma 175%, Age:50-70 gears)Carried on chromoeome 3Sile : s-to% BI.ATEML 2% BII.ATERAT

Macroscopic M Slar shaped mass, wilh areas ofHemorrhage, necrosisEI Grauish, pinkish white in color

M Mass wilh infiltralive edge, areas ofhemorrhage, neorcsisEI Golden uellow in color

Microscopic . Mixed: Epilhelial & Conneclive lissues. ORIGIN: Embruonic lumor . Adenooarcinoma. ORIGIN: PROXMAL CONVULUIED TUBUIESSpread Mainlg BLOOD lo lung) CANIIION BALLOlhers:. Direcl

trEI

Lgmphatic (Uncommon)) Para-aorlic..l.r9l

tr Lgmphalic) Para-aorlictr BrooD.Lung (CANNON BALL). Liver.To renal veins & IVC(FllrlGER lN OtoVEEl

Palienl Child, 4 uears Male, >4O qears

tlnusual presenlalion :2 El Fever o{ Unknown orign (FUO)E Unexplained loss of appelile & weighlE Hemaluria) Late, bad prognosis*E Para-malignanl $PE tf bilateral) uremia

tr Pain is lale (40%)(Stretch of capsule, Passage of BloodClot, lnliltmtion of adjacenl lumbar N.)tr Abdominal swelling (30%)E Para malignanl $(Hgpercalcemia, polgcalhemia, amgloidosis)N.B.

lnvesligalions // FOR DIAGNOSIS:o U/S (shows renal mass) & SPIML CT & Guided biopsgo IVU ) spider leg appearance (elongaled & displaced Pelvi-calgceal sgslemIVU In RCC) DEAD (Dilared, elongaled, ampulaled, dislorted)// FOR 9TAGING) CHEST X-RAY (CANNON BALL) , Bone scan , U/B

// PRE-OPEMIIVE INVESIIGATIONS) CBC, KFI, tFITrealmenl B OPEMBLE IUMOR:Radical Nephreclomgtr II'IOPEMBLE IUMOR:

PreoDeralive ChemolheraDu(Io thrink lumor lo be removedRemenanl of iumor is marked bg clips tofacililale Posl-ooeralive radiolheraDulPosl-oDerativelg:- lf NO residual lumor) Adjuvanl Chemolherapg(Aclinomgcin D, Vinoistine)- lf lhere's Residual lumor) Posl-operalive radiolherapg

tr OPERABTE TUMOR:folal radical hephrec'lomU(Trans-periloneal approach)* posl-operalive lnlerleukin-2tr INOPEMBTE IUMOR:. Pallialive Nephreclomg. lnlerfercn. lnlerleukin-2


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ilP$-41qrr. Uro- our5ary ?lh? r +tofreotment Mild C/O & No Complications) Medical TIT :. AVOID SWs

. Alpha blockers (Prazosin). S-alpha reduclase inhibilors (Proscar)Severe C/O & Complications) Surpical TII:

ODerable cases :Radical prostaleclomg wilh

Preservalion of Bladder Neck,NV [email protected]) Palliative TURP2) Hormonal :. Bilaleral orchideclomg(or Orchiectomg). Eslrogen (PhosphorglaiedDES). LHRH. Anli-androgenMETASTASIS:. Radiolherapg. lnlernal fixalion of angfraciures

Pre-operalive :M Antibiotics & ITI of ang complicalions!nlra-oDeralive :M TURPM VLAPM Transurelhral prosfalic vaporizalionM Open surgerg)Trans-vesical proslaleclomgPosl-operalive :M lrr'rgation bg SalineComDlicaiions of oDeralions :tr Retrograde ejaculationtr TURP Sgndrome

Conrplcot'ions. Acule Renal failure. Psgchological dislress. Hemaluria (Rupture of vesical varices). Urine Retention .... 5W(Women, wine, winler,

withhold of Urine, with infeciion ). Back pressure(Urine relenlion, over-reacfive UB, Chronicrelenlion, residual urine, Bilaleral hgdroureler,Hgdronephrosis, Bladder slone, Cgsfilis)

gPREADO Direct : lo pelvic organs@ Lgmphatics :lnlernal iliac) Common iliac)para-aorlic)lhoracic ducl)Virchow's LNsO Blood :Bone) Lower verlebrae

I

!I

HematuriaUrine relenlionRenal failureBack Dressure

lhre fo over-absorplion ofinigating hgpoiic fluidE$hcts) Hgpervolemia,&rtional hgponalremia,HernolgsisE Prophglaxis). Glgcine for irr'galion. Conlrol bleeding bgamino-caproic acid


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ilR.q41q't . Uro- eurgary ?lh7 r +7

URIWTRACI. KIDIIEY ITIJURIES. URETER IIIJURIES. URIilAtrTBLADDERIIIJURIES' URETHRA II{JURIES


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C/P:l) Minimal shock2) No Periloneal irriialion3) Meteorism ....(Abdominal dislension afrer 24-48 hours due lo hernaloma)

il84-1Mrr. Uro- eurytry ?p{fi t *S

:r.E>-ll:lrrt20%

II

lnfanlsUnderdeveloped Gerola fascia& closelg relaled periloneumto kidnegPrevious pathologg

. Pseudo-hgdronephrosis. Perinephric abscess. Nephrotosis. Hgpertension. Renal arleru aneurusmII AnuriaBad general condilion

C TNTALHCrURE,E;;il. Hislorg of lraurna + Pain in flanks. Mau be) Hematuria ................

examinalionS'gns of Shock + associaled injuriesexaminalion:

. hgp!.!q ) ecchgmosis, Bruises, Rigidifg. Super{icial PalDalion ) Guarding. Deep Palpalion )Superficial tenderness, rebound tenderness. @!q )Shifting Dullness. Auscultalion ) 9lnteslinal sounds. DRE )Fullness in relro-vesical pouch

@Mffi


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?ilRfl-'TB*r. Uro- eurgzry ?W | 50ffiOFllrtaFt/BIrADDERNo desire lomiclurale ininlraruplure,

Calheler oanbe//-used'; )

ttLXlmESTo T-IEORETHRA

ii,!+r a':h!: r_ggjl, J+U n n,!6115 EJr iiig5l+Jl tto gss JiU20% o%Acule abdomen all over abdomenFullness in reclro-vesical pouchX-rag) Ground glass appearance

. Acule abdomen in Suprapubic region. Emptg in reclrc-vesical pouch. X-iaU )Fraclure pelvis

Polg-lraurnafized patienf) Resuscilalion & rnoniloring. frealment of R.uplure bladdertr Midline supra-pubic incision & Evacuate urinetr Bladder is sulured with single lager of Polggalaclin 9lOE Drainage) Suprapubic drain, Retro-Pubic drain - Calheter(Foleg's Calheler is lefl for 5 dags)

. C/O: Acule abdomen in 9uprapubic area

. O/E: Emptg in rectro-vesica! pouch. DRE: Floaling Proslale. X-raU)Fraclure pelvis

tr SC Exlravasalion in complele ruplureEI Striclure (extra-pelvic lgpe)E Slriclure, !nconfinence,-impolence (tnlra-pelvic tgpePolg-lraumalized palienl ) Resuscilalion & moniloring. gupra-pubic Perculaneous cgsioslomg. Urelhra! dilatation


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ARQ-TWW Uro'eurgzry ?l{& t 5l

URIWTRACIllfFl.flttlliATIOtls. PERI-IIEPIIRIC ABSCESS. PrO.]IEPHROSIS


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lfrt+'Tc0!9 Uro- curgery ?W t 6LPERI.NEP;P1

DEFINITION: $uppuralion of Peri-nephric fat & FasciaETIOLOGY:. PRIMARY: Blood born (rare) ... from dislanl seplic focus. SECONDARY: Direct spread (MOST COMMON) ...from Kidneg,appendix, GB, Pleura, Peri-renal hemaloma, TB of the verlebr:aeCLINICAL PICTURE:@ SYMPTOMS: FAHM + Pain &@ SIGNS:* GENEML: , Tachgcardia* INSPECTION: UAbdominal movemenl* SUPERFICIAL PAIPAIION: Guarding* DEEP PALPATION: Loin Tenderness, Rebound Tardeme* SPECIAL SIGNS:O n LoinoO Flexion of Hip & painfulole.l r1fu Lilk Uflro

INVE$TIGAIIONS:* )Diagnostic & fherapeutic*@O AESRo ,t.,t\Trc* PLAIN X-RAYO 9coliosis , obliteration of Psoas shadowO Elevaled fxed diaphragmO X-rag spine) For Poit's diseaseTREATMENT:fr Rest, Analgesics, Anlipgrelics, AntibioticsB U/S GUIDED PER-CUIANEOUS CATHETER

DRAINAGEE lf thick & Multi-tocular) Pus drainale through alumbar incision* C/S *Drain


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?hhe I m

ETIOLOGY:. Ortanism.... EOoli' Roule ... ascending infeclion. Predisposing faclors ... ObslruclionWPE$:. PRIMARY: infection ) Obslruclion' SECONDARY : obslruclion infeclionICIINICAL PICTURE:rlloqJq\o\ais6Ail-odurn s ge\o>\r$ n lldfd

PYONEPHROSIS IS USUALLY UNILATERALIChronic foxernia, Renal

I - General) Acute Toxemia- Local) Throbbing pain, Tenderness, Small swelling (swelling ie large if 2ry obelruction)COMPLICATIONS:. General) Acule & Chronic Toxemia. [ocd) Perinephric abscess, Acule Renal FailurcINVESTIGATIONS:FOR DIAGNOSIS:. CBC) ATLC, AESR. Urine analgsis ) Pguria in open tgpe. U/S ) Dilatation of renal pelvis & calgces. Cgsloscopg ... Chronic cgslilis in open igpe, ln Closed tgpe; Ureterio

catheler mag be arresled at site of obstructionFOR CAUSE:' X-rag ) StoneFOR COMPLICATIONS:. ARF) KFI, IVUTR,EAIMENI:. GENERAL) Resl. Analgesics, Anlibiolics, Anlipgetics. locAt :o OBSTRUCIED INFECTED KIDNEY:frealed URGENILY bg Antibiotias, Kidneg drainage

bg Nephrostomg lube or ureleric calhelero OPEN WPE:l- !F KIDNFT lg FUNCIIONING: IIT. of the cause2- IF KIDNFY !8 NOT FUNCITONING: Nephroslorng3- lF KIDNEY !9 Slltt NOT FUNCIIONING: Nephreclomg providedthat the other kidneg is Normal. fff of Cause , fff of Complications


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ilP$:fCfl"t . Uro' cur6ery ?lq7 1 6+

URIWTRACIOBSTRUCTIUE


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PFEDISFoSINGFACIoRS M T

5UEL4-+W)5.Ont MwMetobolic enor

. ldiopalhic' Huper-vilarninosis D. V Urinaru cilrale. Loss of tdrmina! ileurn(Crohn's dis, reseclion)= IOXAIATE. Cgslinuria

INCIDENCE:. lO-ZOYo of population. Male > Female. Common in Middle age. CALCIUM STONES AREIHE MOST COMMONWPES, Followed buPhosphate, Urales"

' DietO Milk) Calcium sionesOleoO ine. Hot. Randall's Plaque

,.i^ ^tsaarRrPr

(ForMinimStag

@@


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II svswtprous, II 'Drll ,"hl"g pain in FLANKS I| ' C/o of complicarions IffiI .Tili-, of complications II t".S. Renalfailure) |I . Tender Renal swelling I| (Hgdro or Puo-nephrosis) |

COMPLICATIONS:. Painful hemaluria (TOTAL). lnfeclion) Pgonephrosis

SYMPIOMS:. severe @IItrEIN inLOIN radiating to GROIN. Sudden onsel, Shorlduration (


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. !niiial...Proslalic Urelhral. Nol relaled to miclurilion.... Distal Urethral

h)'t

IMOM' PYELO-NEPHRIIIS : Change ofa) Characlerb) o{ painc) uria. PYOa) Painful loin swelling

-lb) Consislulionalssmproms pAl1;1lL Coillp. CYSIITIS :

a) 9upra-pubic painb) Frequencgc) Dgsuria

$f, Anorexia, Hiccoufh, Anemia, bleeding, ComaInfection: Painful hematuria , PguriaObslruclion:l) plqllq; Anuria2) Obsiruction of ureter: Severe persislent pain

5U?4-100N

IIEII.(IERALLoin swellinglf Bilatera! )ARFfrealment :

HrlgnoNlNq Notl-RemoveEtone Hrr{(,nor{Nq0r.lt

il}.IOH' No urine. No desir. Emptg U. Trealmel- RelieNephrectomg .Nephroslorng. Transplantalion

Urele2- lf FaNeph


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Rodio-oPogle*",.*"'PhosphaleCgsleine

IF RES'RRENirORlffiFoRTtrtECAISE. Serum Ca*2, phosphorus, paralhgroid hormone. Stone analgsis. Uric acid' Urine salls

rcR

lF@liPrjem

. Slo. Bac. DiffOII{EFS

lffiFoR@rmrC*rrotS. Urine analgsis. KFT

ilPqA1N5


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OF OF$. Admission. Analgesics)Declofenac lV (Voltaren). Anli-spasmodics (Buscopan). Anlibiotics

FF'{At

ks or accid

@rt

ffiA[liliii:1,:r;:, II acrortlcafion oi unne I

. RENAL)Nephro-lithotomg. PELVIC)Pgelo-liihotomg. SfAG HORN> ExlendedPgelo-nephro-litholomg

,[" ".rnp1,""tt."-

ilPqJw$/sTO

ORETER BIADD

Failed conservaiive TIlf complicaled sloneslf >O.ScmWE HAVE TO TRYINSTRUMENTAL TIT.FIRSI & IF FAILED)

DO SURGERY


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${ t,RerER

DEFINITION: Obslruclion angwhere in the urinarg lract associawith changes in the urinarg sgstem proxirnal to the obslructioPMmw

$.I ONETHRAtatld

Cr{Rotlrd nergltnorl

rb'|td ffmns, Is.lr @MnN t,NeTER.crrl[,CO!{F,A}IOR'A


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HrDFoHto(|1$!DEFIIIIITION:. Aseplic dilalation of Pelvi-calgceal sgslem due lo intermillenl obstruclionETTOTOGY:

cilPq-4Mr1. Uro- euryzry ?fQ7 t A

PAIHOTOGY:. Exlra-renal Pelvis. lnlra-renal PelvisCTINICAL PICTURE:. Dull aching loin pain , A bg fluid inlake , OlE > palpable kidneg. Clinical picture of Etiologg:l) Stone) Colic, hematuria2) BPH) Prosiatism3) IB)Toxic sgtnploms, frequencg. Clinical piclure of Complicafions:l) lnfection ) Hgperlension & Fever2) ARF) if bilaieral hgdronephrosis, or Unilaleral wifh one functioning kidnegINVESIIGAIIONS:

. U/S) size of kidneg, thickness of corlex. lVU) Flattening, Clubbing, Ballooninglf IVU is # ) Ascending Pgelographg. For cause) IRU/S. Cgstoscopg. For complicalions) KFT, Urine analgsis, CBC

-IREATMENT

HrlwnoNl}lq ib.tflrr{anoNrNq HrNenoilD{qTTT of cause Nephreclorng 'il;".'1,"0""',11"' NePhroslorngkidneg . lf improved)ITT. Of betlerfuncfioning kidneg. lf nol impr.oved)

Renal Iransplanfalionf Re-conslruclion bg "ANDERSON - HYNE$ OPEMTION"or Recentlg bg "ENDOSCOPIC PYELOLYSIS". Stones) Rernoval, BPH) TURP' Phimosis) Circumcision

. ARF) Transplanlalion. Pgo-nePhrosis) Drainage.Antibiotics

. Stones... Renal TB. Pelvi-ureferic junction obslruclion. Horseshoe kidneg, Aberranl renal vessels. Ureterocele. BPH. Congenilal conlraclure of Bladder Neck. Bilharziasis. Phimosis

f.-rlllllfFrrll


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ilR4-10q\r. Uro'eur6ery ?l$t t 6tUo*ln^ereo

TFEAn$Eltr .iHoc.tr+ErER. l- rnetnlqlr -l

o,{rt 62,

RelbvdI

lf NstRcltevedl!9urgtealromovat

. Bilaleralobslruclion. Unilaleral obslruclion(lf olhet kidneg is congenilallgabsenl, surgicallg removed or

. BPH' Slone. Ttauma. Reflex (Post-operative), Psgcholo$calCIIIfiALFEIIIffi,tfHFFofl,tS SIAGE OF ONSEI:. Ureleric colic. fender Renal angle. Emptg UB. No Urine, No desire

SIAGE OF IOLEMNCE (3-8 dags):. Pain graduallg disappears, 4BloodSTAGE OF UREMIA (after few

Relenlion) Supra-pubic pain, lnabililg lo passurine inspile of desire, Sgmploms of cause)Slone, BPH, Hislorg of lrauma

. SIGNS: Kidneg) Loin swelling

CAIHEIER + ...EI Plain X-rag , U/SM AscendingpgelographgEI CgstoscopgN.8.... IVU is #DONE AFTER RETIEF OF OBSIRUCTIONM Pelvic U/SEl For Cause: Slones) X-rag, BPH)

TRUS

ffTOFCN6ES:

\,'"

tt


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ETIOTOGY:. Urelhral Slriclure, BPH, BNO, TumorsCLINICAL PICTURE:

. SgrnDtoms) Painless UB swelling , Frequencg. SiQns) Full UB. Nol tenderINVESTIGATTONS:@ Pelvic U/S@ UREA LEVEL@ For cause@ For complicationsTREATMENT:. FOLEY's CAIHETER!f urea > IOO ng% ) GRADUAL EVACUAT1ON

. TTT of cause ... DRE, BPH. fTT ol Complicalions ... Hgdronephrosis, Tender loin mass

ffiOFORI}\|E

ETIOIOGY:. PUJ. Urelerio-Vesical junclion obstruclion. Posl. Urelhral valve. Slones

Ct!N!CAL PICTURE:. Abdominal pain + Abdominal swelling (Hgdronephrosis, or dislended UB).Clinical picture of complicalions) UTl, HernaluriaINVEgTIGATIONS:


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1JE4-100.t . Uro- ourytry ?lQY r tA

. REJTIALAIIOIIRI.IES. UR!ilAtrf BLADDER A'll0I,lAL IES. URETHRATAiIOTALES


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CtItt|ICAL P!CTURE:- Abeence of lor,ver abdominal wall +Anl Bladder wall- Widenin! of Sgmphgsis pubis ) Waddling gait- Genitalia: lii;Loir! 0+:Ji''o-.O Epispadius (EXIROPHY -EPlgPADlUgcoMPLDoO Rudimentary prcslale, Seminal vesicles. penisO Bifid scrolumO Bilaleral undescended leslesO Bilaleral lnguinal herniaO Associaled anomalies (e.9. Spina bi{ida, Cleft

liP)Complications:. Cgslilis & Ascending pgelonephrilis. Ekin Excorialion, Ulcer, bleeding, bad odour. Bladder Carcinoma (chronic irrilalion)lnvesligalions : plain x-rag (Wide separalion of sgmphgsispubis), IVU (For associaied Urinarg lracl anomalies)Trealment :E Temporarg closure of defecl al birth!t Bladder augmenlalion laler + Pelvic correciiveosteotomg + phgloplastgfr lf conlinence cannol be preserved) permanenl

diversion

51Bfl--T1qrr

Contain Muscle FibersWithin its wall)ContractileCLINICAT PICTURE:- Male >5o searc' Accidenta

- OF COMPLICAIINS: Frequenc

Trealmenl ) TTT. of lhe cause, Div

l- Hgpertrophg of lnlernal sphincler wilh dev(MARION's DISEASE)2- Fibrosis of lissues of Bladder neckM lnvesligalions: Uro-dgnamic studg) Raised vM Trealmenl :Alpha blocking drugs "Prazosin", Surgcal " fran


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@a TYPES & ETIOTOGY:

D-o

EUM opens onundereurface of Glans

penis

Clinical picfure depends on Age :* At birrh) iltitloJliirduro )hooded prepucee 2-lO gears)ai,i 9i ) Wetting clolhes in miclurition* After pubertg) Uirili+t, ) Bowed penis downwards during ereclionlnvesligafions :. Hormonal assag & kargolgping ... For associated condilions. Ascending urethrogram posl-operalivelg ... to asses success of surgergfreatmenl :

shaft of lhe penis, Dislal part ofurelhra is replace bU fibrous lissue

g

Failure of fusion of inner

frfr PRE-OPERATIVE) Rernoval of Chordae, injection of saline for ereciionOPERATION) Urelhral reconsfruction (recentlg: arti{icial tube)l) GLANUTAR) MAGPI opetation2) PENILE) DUKEIIE operalion3) PERINEAI) UB mucosal{lapPOST-OP) Circumcision

Urelhra opens in-belween,Penis is rudimenlargwilhin undescended lesles

f/'I?4-jf00t\r

AtlM CIINICAI PICIURE

urinarg obslructionCongenital or acqu,.BALANITIS XTfT: Circurncision

- Micturating Cg(Dislended poslerior- u/s

(Dilated, Pelvi-ccorlex, dislen- DMSA scan


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ilRq,-T1qrr. Uro- eurgen ? hq7 t 6


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(anlerior > Polar). lmperfecllg descended leslis. Long mesochorium. High inveslmenl of Tunica va$nalis. Spirallg aftached cremasleric ms.. Separalion of Epididgmis from bodg ofteslisPrecipitaling faclors :. Sudden strain

Organism : .. [email protected]"oli. staph.Mosl common sexuallg lransmifled

causeRoute of infeclion :.Along Vas , Peri-vasal [Ns , via !!gg]slream

/ fesiicular swelling/ Refllex sgmploms) N, V, collapserr GENEML: Pallor ,swealing ,tachgcardia,/ Due lo imDerfect Descended Teslis:)Emptg scroturn, swollen lnguinal canal/ On top of ComDlele Descended Tesiis:l) Scrolum : swollen, lender leslis ,Cord : fwistedTeslis : h'rgh, fender, associaled

/ Eliologg ) Dgsuria, FAHM/ GENEML: Fever[OCA[:,,/ Scrolum :red , inflamed skinl/ Epididgmis : Enlarled , lender/ Associated hgdrocele/ lf abscess is formed ) Pus loculus

CcrnpkairB Gangrene wilhin 6-12 hours

Urine analgsis ) Freetrtr

tr Doppler, Duplex:Teslicular vessel is PATENIE Urine analgsis ) @tEEI lN THE FIRSI HOUR: unlwisl usinggentle manipulationM Correct general condilionM Emerqencg lrealmenl in earlu cases :

Untwist cord ) Orchiopexg )Eversion offunica ) Orchiopexg of olher testisM if lale cases : Orchieclomg & orchiopexgof olher leslis

lf chlamgdia ) Doxgcgcline IOO mgM Acfive IIT :l) Resl (elevation of scrofum),Antibiotic, analgesics, antipgrelics2) !f abscess is formed )Drainage


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CoXcrrlrrluDue lo persislence ofprocessus vaginalis

E Sac connects wilhperitoneumtr Mother complainsthal her babg has aScrotal Swellin( +bg dag & n'rghr

tr S'rgns)Swelling:l) lnguino-scrotal2) Cgstic(Bipolar lesl)3) Translucent4) Non-reducible

E freafmenl :Conservalive TTTfor 6 monlhslf no sponlaneous

improvemenl occurs)Excision of sac lillinlernal ring

tr Sac has NOconneclion withperiloneum

tr Mother complainsihai her babg has aScrolal Swelling+

1Hvrc,rr{AuINCIDENCE. Middle aged male. Fluid is ExudaliveCLlNICAI. PICTUREtr C/O : painless swelling in one oflhe scrolal comparlmenlsA O/E ) SWELLING:. Unilateral.trEENtr. Non-lender' Cuslic, lranslucenlII{VESTIGATIONStr S'rgns)Swelling:l) tnguino-seolal2) Cgslic

5UP4-1W\5.

3)4)(Bipolar lesl)

TranslucenlNon-reducible

M Encgsted hgdrocele of c" See DD wilh sDermalocele

E Trealment :Eversion ofTunica

Vd Hgdrocele of hernia sacDiffuse hgdrocele of cor

DEa p

TREAIMENTr) LORD'S OPEMITON:Plication of lunica vaginalis2) Sub-lolal excision of Tunicavadnalis in cases of calcified,loculaled, and recurrenl.3) Eversion for small hgdrocele

N.B. ASPIRATION lS # Except if badgeneral condilion as il mag lead lohemalocele, pgocele,

recurrence, injurg of ieslis

DIFH'SE }gDROCFI.E OEliologg:Chronic lgmphalic obslruclion "FlIAClinical picture ) TYMPH. EIEEEI' lnguino-scrolal(No expansile impulse on cou' Cuslic , Translucenl. lrreducible' Soft' Dull. Diffuse. Funiculilis is commonM


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INCIDENCE, AEe: bet. Puberlg.@ETIOTOGYtr PREDISPOSING FACTORS: Congenital mesenchgmal weaknesse PRECIPITAIING FACTORS: AVenous pressure (prolonged slanding ,slraining, venous congeslion )

CTINICAT PICTUREtr C/O : usuallg asgmplomalic, Pain, scrolal swellingA O/E: Swellin! :. Lefl side hanqs lower lhan riphl, Scrolal skin show dilaled veins. Palpalion :l) Ecrolal neck lesl) Fullness al neck of scrolum

-35 gear

3) Associated with a small lax 2rg hgdrocele4) To differenliale fiom SECONDARY varicocele) Thrill on coughINVESIIGAI!ONSx Semen analqsis) Slress pallern (asthenosperrnic, Oligospermic).. for medico-legal imporlance ..x Duplex scan ) reversed blood flow bilaterallgtr Scrotal, lrans-reclal U/S) for visualizalion & Gradingx Abdominal U/S)exclude 2rg varicocele (Hgpernephroma)IREATMENItr CONSERVATIVE) Psgchological supporl, Scrolal supporl, Cold bathto scrotum, avoid conslipalion & pelvic congestiohtr I approach, Reiro-periloneal, Laparoscopic Varicos-eleclomg,

ilRq4)U\r.

Perculaneous venous embolizalion

DEFINITIONcremasleric

VENOUHow lo di!NCIDENCE. Old maleEIIOTOGY. @..". Relro-perCTINICAL P!C. Co

I

sls . C/O: severe. fTT: RAAA, elZ 2rg HgdroceleM Testicular atrophM Neurosis


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SEltttNoriA40%

TERATOMA32%

SmiiJ+.oj


76/157

A,EI4J0NL Uro- surg\CEI,LffilfrrtO20,-25 ri!.j lstr

, Undescended testis . Carcinoma in silu. fedicular desgenesis (klinefelter's $) . Trauma. HtV . Geneiics: " ISO-chromosome 12 p " (8O7oof leslicular lumors)@ [ar!e , firrn , smooth@ Cuf seclion : Homopenous , Pink@ Hemorrhage, necrosis

@Cul seclion : Heleroqeneous,uellow@ Hemorhage. necrosis

Micro-scopicpiclure : Sheels of rounded cells with large nuclei ,infiltraled with lgmphocgtes

(Good prognostic indicator) Malignanlleraloma tropho-blaslica

"CHORIOCARCINOMA"Teraloma di$erentiated (Dermoid cgst)

@ Para-aortic) lhoracic duci) Virchow LNsoI lOCnl: spermalic cord,epididgmis,scrolal wallLungs are the {irst site affected

Painless swelling wilh senee of heavinessPainful in advanced cases, if Hemorrha4e occurs. Tesfis is enlarped, hard, heavu , {ixed with Enlarped Para-aor}ic [Ns

V h{qb t 71

M Rapidlg accumulaling HgdroceleM HURRICANE TYPE ... fatal wilhin l-2 gearsM Piclure simulatin! acule Epididgmo-orchilisM Abdorninal mass with Empfg sootalin a patient wiih undescended festisM OCCUTT MANIFESIAITONS:l) SEMIIIIOMA) Enlargemenf of Virchow LNe2) TERATOMA) Lung metaslasis


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?JrrtOlnvesligalions FOR DIAGNOS!8:MScrofal US) mass. calcificafion

Mfumor markers :SEMINOMA TERATOMAB.HCG

TDH a- FeloDroleinZFrozen seclion biopsg (inguina! approach).. FNABC is # in leslicular lumors

FOR STAGING. Bone scan, CT scan , abdorninal U/S, CXR. IVP) distortion of ureleric course (Para-aortic LNs metastasis)FOR FOTLOW UP

. lumor markersPRE.OPERATIVE. LFT, KFt, ECG, SuEar, urine..ITaI

l)fedisll)LNs below diaphragmlll) LNs above diaphragmlV) Distant melaslasis.. HIGH INGUINAT SIMPTE ORCHIECIOMY "# Radical otchieclomu ) Para-aortic [NsSecondarglrealmenl : according lo lhe slage. I ) Radiolherapg lo Para-aortic LNs. ll) As 9lage I + Radio-lherapg lo

mediaslinum. lll , lV)Chemolherapg

. l) repealed assessmenl. ll , lll, lV ) As Slage I + Chemolherapgcombinalion. lf NO dislanf melaslasie) RefioperilonealLNs dissection wilh initial TTI.

trtrtrtrtrtr

dsr"lPre-pubertal iumor )Precocious puberlgMasculinization of patieniHgpertrophg of other testis

1JP4-10q\r. Uro' eurgzrrl ? AkV r 7+

6l.pj 1'J! J=piJI JgriPosl-Pubertal lumorFeminizalion of paiieniGgnecomaslia, loss of libido, aspermia

Treatrnent for both cases: ... OR,CHIECTOMY


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@ DEFINITION: Relenlion@ Fluid Confains:

@ DEFINITION: failure ofobliteralion ofof processus vaginalis

@ DEFINITION: Cgsl ofvestigial slruclure"Hgdatid of morgagni"

@ Conlain :l) Clear {luid

oJc)E(!.9L:o

@ OtD MALE WITH PAINTESSSCROIAT SWELLINGiiiJU iif-ai orir Ul Uurrtr@O/E ) SWETLING. Painless. Cgslic' Al upper pole of lestis'!!else@leslis bu inlerval

@C/O> Painless swelling inscrolumOO/E) Swelling:. Painless. Cgslic , lranelucenl. SeDaraled from leslis bV inlerval. Mobile across cord) mobilitgVon down traclion of testis

@OlE : mulliple lrans-illuminaiion

Uro- our6e.ry ? hk* t 75

GqnoNrC epruU^ioong{rnsr) cHRoNrc NoN-sPEcrFrc EPTDTDYMO-ORCHTITS2) TB EPrDrDYMrIrg@ C/O: sgmploms of TB loxemia, urinarg TB@ o/E:tr S'6ns of TB loxemia , urinarg TBtrEpididgmis ) Enlarged, lirm,tr DRE) fB nodules in proslale, seminal vesicles@ lnveslilalions:l- Urine analgsis) Slerile pguria 2- C&g on Lowenstein media 3- IVU)Detecl urinarg TB@ IREIMENI:. Sanalorial lrealment + Aili-fB drugs. lf no response after 2 monlhs) Excision of Vas deferens & Epididgmis3) BTLHARZTAL MASSO Mosl common Roule) Vesico-proslalic plexus of veins@ VAg Ig INIACI, VEINS AR.E BEADED4) F[-ARrAgrS (ENDEMTC FUNICUUTIS)@ CORD 18 THICK AND MATTED , VAg IS MATTED

@o PaMacroocopic piclure:

accordihg lo roule O LYMPHAIIC ) Tail is lhe firsl sile affecled, Vas is thickened & beadedO BOOD) Head is lhe lirsl sile a$ecled , vas is NormalMicroscopic : O cenlral caseafion. Lanperhans pianl cells, {ibrcocules, eoilhilioid cells


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A,W{4-jtC0{f- Uro- curgtry ? h** t lb

. WILM's TUMOR:- One third of palient wiih wilms tumor presenl wilh value abdominal pain , wiih minor lraumaand hemorrhage with in lhe lumor- Neuroblastoma is a childhood supra-renal lumor wilh bone Secondaries ,enolase *ve VMAin urine and frealed as wilrns iumor- ln TIT o{ wilms lumor: lhe use of chemo& radiotherapg have improved lhe overall prognosislo SOTo and Earlg cases are usuallg cured

. Urinarg bladder carcinoma is lhe most common urological malignancg in Eggpt. lN BPH there is no relalion belween lhe size of the prosiale and degree of sgrnplorns ,theseveriig of sgmpfoms depends on lhe degree of urelhral and bladder neck obslruclion. CANCER PROSIATE: lhere is delaged spread lo lhe rectum due lo presence of fascia ofdennonvilliers. UROLOGTCAL INJURIES:- Anuria as a complicalion of renal injurg mag be due to : shook, reflex inhibition of both

kidneg ,clot relenfion, injurg solitarg kidneg. INJURY OF IHE URETER- Mosf common cause is IAIROGENIC (During open surgeru especiallg pelvic surgerg)- Diagnosis :O UNIIATEML: SILENT ATROPHY OF IHE KIDNEY (Most dangerous), Loin pain & swellingO BILAIEML: Anuda or oliguria- INVEBTIGATION:O Ascending relrograde urographg showing obslruclion or exlravasationO CT scan wilh conlrasl showing exlravasalion of the dge- TTT:O lf immediale diagnosis:- Fair patienl condilion: urefero-vesical continuilg, Restored bg lsl anastomosis- Poor patienl condilion: hephrostomg for drainage of utine lhen delaged repairO lf delaged diagnosis: lemporarg nephrostomu lhen delaged repair. URINARY IRACT INFLAMMATIONS: Earliest macroscopic specific aPpearance of the bilharziasisof fhe urinarg bladder is bilharzial pseudo-tubercle. Siles of impaclion of Ureleric sione- Pelvi-uretericjunction- At Ureleric ori{ice,- At the sile of crossing of iliac arteries- At the sile of crossing of the broad ligamenl in females- At the sile of crossing of the vas in males- At fhe sile of enlrg inlo the bladder wall. l3-9O% of small urinarg slone


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Teslicular Turnors@Most oommon fedicular lumor is@Most Mal'gnant Teslicular lumor is(Earliest leslicular lumor melaslasizing lo TUNGS)@Most common presenlalion of fesficular

neoplasm is a "Painless mass"@Loss of leslicular sensalion : Seminoma,

Sgphilis(Earlg complete loss of sensalion) SEMINOMA)@ ofthe teslis respond

@ Tumor markers:. Ovarian carcinoma) CA 125. Teslicular seminoma) B-HCG, alpha feloprotein.Ies!!cu!ar!era]oma.2.8-H0G,LD|{. @Alphafetoprofein. Proslalic carcinoma) PSA. Coloreclal carcinoma) CEA

EllQaAA{Fournier Ganlrene/ Mag follow minor injuries lo Perineumrr Sudden onsel of scrolal in{lammalion *

sudden onset of gangrene (oblileralivearlerilis)/ Caueed bg rnixed infeclionHEMOLYIIC $TREPI. + 9laph * Ecoli ..elc/ Mag be associaled wiih NeeolizingFasciitis) anterior abdominal wall

/ lrcalnenl) Antibiofics & wide excision+ skin graftVgg

al anornaliesfeslicular arresl is associaled wilh urinarganomalies in 15 7o of casesUndescended Testis is prone lo Torsion,frauma, malignancgMost im ic lool in arresfedlestis isM lf teslis is nol found bg laparcscopg :. Teslicular agenesis. Felal festicular torsion. Maldescended lesfisM Most common sife for @!E lestis is@@ @ lurr "rp".f'"irl inguinal pouch

M Ectopic leslis is due to rupture of scroialtail ofgabernaculumM Best treatment for Relractile leslis is Re-assuranceM CRYPIORCHIDIEM:. Occurs in 5% of new bon babies. Laparoscopg is the besl diagnoslic melhod. 4 Risk of mal'rgnancg. Associated wilh V Ferlilitg

Hgdrocele, VaricoceleMosl importanl dia8noslicrfealure ofSECONDARY HYDROCELE mag be due lo:l) Teelicular lumors2) Teslicular lorsion3) Epididgmo-orchilis4) Following HerniorrhaphgFluid :a) Crgstal clear ) Epididgmal cgslb) Barlg Waterg {luid ) spermalocoeleHEMATOCELE:- Iapping of hgdrooele is lhe mosl commoncause of hemalocele- Old clotted hemalocele rnag simulaleteslicular lumor

MISCETLANEOUS:


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1M-TWI'.l. Palienl 40 gears old presenls wilh dull achin! pain in

{lanks and irregular upper quadranf abdominal mass wllhmild impairment of renal funolion. UB show mulliplecgsle in bolh kidnegs.6ugw6a/ pQcystrb kAtq.

2. Palienl presenls wilh loin pain, swelling and feverusuallg after pelvic surgerg'llreter t@tr,3. A polglraumalic palienl presenls wilh supra-pubicpain, He was in agong io Miclurale before the lrauma, Bul deehs afigl lhe lmumax-rag shows ground glass appearance and UB shows {ree fluid in periloneum,

/ntra- Ventoteal aVtre rtnrtary blafuer4. A polgrtraumalic palienl presenls wilh supra-pubic pain and urine relenlion wilh desire lo miclurale.X-rag shows fraclure pelvis.

E xtra-?entottu/ rl?tilre b/d&t5. Palienl wilh historg of irauma to perineum presenls wiih, Few drops of blood at tip of Penis, perinealhemaioma and urine relenlion wilh desire lo miclurale. trhra plwb rult/tre trethrd.B. Adult palienl presenls presenls wilh righl loin pain increases bg movemenl, respirafion and coughing&heclio fever. Plain X-rag shows scoliosis wilh oblileralion of psoas shadow elevalion& {ixalion of lhediaphragm. Urine analgsis is slerile.

Pul-ttelhrb abscss,7. Adult pt. with Hx oI renal slones, C/P: Anemia, fever& large renal swelling. Urine analgsis shows pguria.Opn t4pe V4onephrosb.8. Middle aged usuallg male presenls wilh hemaluria, markedlg increased pain & frequencg.Cgsloscope

shows sandg palches or olher specilio lesion. Bilharzial anlibodg deteclion bg ELISA is posilive.Blrharzrhsrb of l/8,9. Middle aged male presenls wilh dull aching pain in flanks associaled wilh nausea and vomiling. USshows radiolucenl or radio-opaque shadow. &ta/ co/rblO. Palienl presenls wilh severe agonizing pain in loin radiating lo groin of sudden onsel short duralion

associaled wilh nausea and vomiling .On examinalion rigiditg of lhe laleral abdominal muscles./,/retenb co/rb Gtond,ll. Palienl with historg of slones or BPH presenfs with mild pain in loin ihcreases bg excessive fluid inlakewith dragging heaviness in loin, IVU shows palienl has a renal mass in lhe Loin

HydronVhrosb,12. Male above 50 gears old presenls wilh painless, recurreni, profuse, lolal hemafuria. Mag be pain or

renal mass or other non-speci{ic sumploms, polgcgthemia. IVU shows dislorled pelvi-clagceal sgslemReta/ ce// carcimna Hyp.rnphnna. ) (Qrayfrtz funor)13. Old patient wilh historg of chronic ir.ritalion lo UB or Bilharzial precancerous lesion presenls wilh

exacerbalion of sgmploms of cgstitis. (Painless lerminal hemaluria, necroluria, frequencg anddgsuria).lVU ehows irregular lilling defect or jusl irregularitg in the bladder wall.6aner ttrirtanl b/ailer (TG or 366 accorditg to Vrdispsug factoD.14. Male above 50 gears old presenls wilh frequencg of miclurilion, Dif{icultg lo slarl, lo mainlain and lofinish, 4libido and urine relenlion. DRE showe lhal prcslale is sofl, smoofh, sgmmelrical, preserved

median sulcus, noloh belween il and seminal vesicles is preserved & mobile mucosa of reclum over il,B u,,!t Pros tatb hTprV/as b15. Black old male palient presenls wilh sgmplorns of difficult to slarl, lo mainlain or lo {inishmicluralion. DRE shows lhat the proslate is hard, asgmmelrical, With Backache

Garuer prostate.


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5u?q40ar5. Uro- eurgtry ? h+* t n

Babg with an ernptg well developed scrolurn, normal lesfis,O/E lhere's Exaggeraled cremasleric reflex

lnfant presenled wilh an ernplg poordeveloped scrolurn wilh or wilhoul

associaled renal anomalies.

lnfanl or Uoung adult with sudden severe,testicular pain, absent cremaslericreflex, duplex shows obslruction of teslicular vessels & urine analgsis is freeSECONDARY VAGINAL HYDROCELE

Middle aged male with rapidlg accurnulatinghgdrocele & Pregnancg lesl is POSITIVE

Middle aged male with signs ofcongenilal rnesenchgmal weaknesswith or without dragting pain in lesliswhich disappears on lging down &elevalion of leslis.

\

:\

\-/t

'{

Middle aged rnale wilh AbdorninalMass, Painless swellingIn testis & loss of leslicular sensalion.


83/157

ilRt4'-T00tr5. Uro- euryzry T t,k6 t U

Hgdronephrosis : Eliologg , ClP,lnvesliglalions& TTIG4rh s/rams,2@ - .4u s/ans'2M - ,4y'rar fi2@4 - Aztrar rll,2@ )

Discuss Unilateral OR bilateral HgdronephrosisHgpernephrorna " Renal cell carcinorna ": Diagnosis& TTT

G4ilr alarr/s,2@22@52@- Kaan2@8 - ,4h starr/s'2@2-2@52M )Management of renal lumors ( Ailart,2@7)Acule relention of urine

( 5u shan&2@52@5 - AZar ril,-zozZa4Zan)Manalernenl of obslruclive relenlion (Aushatrs,2ffi )Causes and rnanagemenl of relenlion

( z4zzhr f,2@7 )G4ths/ans'2@4 )

(Kasn 2d/)Tgpes of renal calculi , TTT of Kidneg slones, TTT of lower end ureler slones

G4u shans,2d- Kasr, 2@7 - Ay'rar f,2d - ,Qst 2@a - Ay'rar f,2@)Calcular anuria (Kailzd)Give explanalion for ihe following : Whg bilateral orchidectomg mag be indicated for ttl ofadvanced proslalic cahcer Kasr,2@6 )BPH : C/P complicalions, indicalions for surgerg

( Kaan2W -,4y'rar F,2@ - Kast;2M -Ailarrlr1,zml Kasn2%)Eclopia vesica: C/P, Radiological finding , comPlicalions (Kasr2M )

( Kasnzd)G4ilarf,2ob )

(,4zar rl/'zo// )

Rupture Kidneg: ClP , lll and follow upUrelhral injurg

Give an accounl on leslicular lumorTorsion of lhe teslis : ClP , DD and invesligalions


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ilR4-10A\5. Uro'lurbQry F&** t 8l


85/157

5UR(+'T0A\5. Uro' eur6zry ?&*5 t 6L


86/157


87/157

ilR4-10N5. tkuro- luryzry ?fQY t *+

r


88/157


89/157

EIIOLOGY:Blunl lrauma bg a wide surface area (Wall)SITE: Starts al sile of impaot & Runs awag from ilCOMPLICAIION9: ... LESS THAN DEPR.E$8ED FRACTURES. Hemaioma, Bleedirg

ffi. lnfeolion, lntracranial l{emorrhage. CgF leakage, Epilepsg

TREATMENI:l- First aid (ABCD)2- himatg suweg3- 9eoondarg surv6g4- At hoepital:- CONBERVATIVE: likesubdural Hemomhage- TfT. of associaled leeions if presenl

ilRq-T1qrr.

l\:1Sn*lne

I


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AATSES (i])l) Fractural Ternporal bone2) Fraclure Parielal bonga3) Without fraclure in Children

SooRcE oF BlEEDlrc' (ll)l) Cornmon )Anlerior branch of MMA2) Serious ) Venous sinus t3i tnsignificant ) Diploeic V6ii!

lis

5UP4-A0ar5.DEFINITION: Hemorrhage belweenMosl comrnonlg im Temporal &

snAd+s (il)l) Stage of CONCUSSION2) Stage of LUCID lNTERyll3)Slage of COMPRESSION

Vilal Data:Pupils d\ \re \n V otr(Equa!, Reactive)

iting rl_I


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HBD FACW nt qlE lntracrania! HemorrhageE Brain EdemaE Dural leartr Fislula (Carotid- cavernous)E Abscess - OsleomgelitisEl Cranial N. Palsgtr Whiplash injurg

HEC - MPDA o$D d\bE Headachetr EpilepsgEtr Cosmelic deformilies in SkullE Meningeo-encephaloceleE Posl-traurnatic Hgdrocephalustr Sub-dural HemalomaE Aneurgsms

troLyPRIMARY SURVEY:

ABCDE, Resuscilalion & MoniloringSECONDARY SURVEY:- Exposure- Head lo loe examinalion- Ample HistorgINVESTIGATIONSCONTINOUS CARE & OBSERVATION

flP$-T)qrr. t

PffiEDIT

tr cr SoAN)

TI

\ M&M ;6e si

soRc'lc{tff8co*rnouBI,^EEDSurgical Drainage lo evacualeAcule Inlracranial Hemaloma


92/157

wtcAtrlT : iihlr,^crd,,riQueslion mark incision r ( rt InI'lrir;ir':'i Siijlnii riri g l^rr'i6 iTernporalis muscle Jl .-EIUOsleoplastic Flap rJori... elrrj! 1'ilti.orSaline Jl g iibl6 rir l! a l#rir ... pJ Eill"rItf lgd.o oI! 1-gllr ... pJl Jliri IoJ

gaftJq nrr^liiiForamen dl cJcsPinosurn

ilP4-T)Urr.

ECA dl blri

IIIIII

tjl r.r.a nosfi g'f.41qJTernporalis FasciaM PosM AnliEI Antipres

EIRemM Rer


93/157

SoBo Dueto ruplureof @o

^

Bilateral & SeverePersislenl loss of consciousness

(As it crosses the subdural space)

o cr:q@E@$ffi;il"J]o

Morfalitg up to !@Trealmenl : (As Extradural Hemorrhagrlnlraoperalive, lhe Dura is:. Bluish' Tense. Non-pulsaling

SURq-4)grr.

Alherosclerosi" gr? I.1 .. gr

Sudden displ) ruplure

O ETIOLOGY:- Mosl common cause i* IEEIE@- 2nd rnosl common is Rupture " Berrg's aneO CTINICAL PICTURE:

Hr-

5h-o oJgl,V

(Headache, blupersonalitg ch

oo INVESTIGATION OF CHOICE:

"'+,\ TTT:WtrTREATMENT: Endovascular Coiling * Evacuatio


94/157

5UP4-1w$ Ncuro- tuW\ ?lh7 | 7


95/157

?ilP4-100'lr. &trro- 5urbQry ?lhY | ?PERIWNOIW

ffi+ TINEL'g SIGN(FOR FOLLOW UP)lighl percussion on courseofnerve fiom belowupwards) Iingling

ln Closediniuries

Fasciculalionsafter 2-4 weeks

ln Openinjuries

QUINIZARIAN POWDERAnhgdrosis) No coloralion

o,:lr!:.1:aDlf lhere's Failureof nerve repair

. Compleie molor loss. COMPIETE sensoru loss. Degeneratio" N. Recoverg afler surgicalrepair ONIY. Besf prognosis withPURELY MOIOR injuries

injurg of MEDIgctATrc N.+ PALPABTE NEUROMAMag be ed nerve

nSrrNo abnormalitg

detecled inNeuropraxia


96/157

ffi PENPT{ERAtNEF\EMClosed injuries:- Neuropraxia- Axonlemesis

II+M SplintageM Exercise & MassageM ElectrotherapgM Prolection of Skin

gVg

M NeuronternesisM Open injurg or Closed withfailure of recovergE Palpable Neuroma, finnel's sign

IMMEDIATE SUTURElndicalion: lnjuries duringoperationsDisadvanlaqes: Thin Nerveshealh

5UR4-100N1.

(3.1-weetaafterinjwy)tAl Time of Wound repair:Approxirnale 2 ends of Nerve bgblack silk sulure3-4 weeks laler:/ 2 ends are cul & Exposed & Trimrnedz/ Apposition of Nerve sheath/ Repatu (Epi-neura!, lnlerfascicular )

Or'-lrM lmprove f

Recoverg

ArthTenArnUlc

ggV

gVVVV

NeuDivfranNerFix3 w


97/157

;

oF PERIPHERAL, hI. Tr{g,xEstr ttlnsr:

Ooponens Pollicis ) Ape M Hupolhenar Ms )WASIING(Loss of abduclion of litlle linger)M lnterossi) Guflering, Nofanning, no abduclion

ctAw I{AND! (Extension of MPJ + Flexion of IPJ)

tesr)

A.)Rq-{1A\r. &t tro- lurbQry ?rQY | 1+

(Iested bg counling {inger lest)Flexor pollicis btevis ) Partialloss of Flexion of Thumb(Tested bg pen touch lesl)Abduolor Pollicis brevis2Lalerul lumbricals

c9ur{TriloFINGER IESI

SrrrlSonl/r.GSl:Laleral AO of palmar surfacetaleral 3& Yz ingercDorsum of lerminal phalanges

Arrr^pd:M Flexor carDi Ulnaris ) Weak

flexion of wrisl & Loss ofNormal Ulnar deviafionM Lateral /z of Flexor di(ilorumDrofundus) Ulnar paradox

(Exfension of Terminal phalgnx ofmedial 2 {ingers)

SEhUSm/ roGlS:AI WRIST:- Medial l/3 of palmar surfa- Medial l& t/2 {ingers- DORSAT SURFACE IgSPAREDAI ELBOW:- DORSAT & PATMAR

Surfacesare affected

gsdg


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ilRq4w-15. ttunro- ,urba\ ?AqY I T

Spira! Groove rjlr--s qirp SJrijJ Long head of lricepsWRIST drop + {inger drop #tuirJl Usl+i,JlL,f SJ Elbow Jlr",'tJ? gPosterior lnterosseous N.r-s.ii Exlensor carpi radialis LONGUSd @Jai'JtUeni

Radial N.lnjurg AlFlhow

FLEXION OF THE ETBOW( l-f TricepsJl)Exlension dor,t tjlo.o ...HOWEVERphiu J+oJ loJ of ElbowPRONATION(Loss of Supinalors)Supinalion Ja.q Ulo, ...HOWEVERBicepsjl1'lr UiLi-61


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AR$4WI, &uro- ,urff\ ?tQY 1 1b

agg Acutechronic

NCV (Nerve conduclion Velocitg)EMG (Electrorngographg)

gVgg

CAFPATTUNNT-USTNDNONTEDEFINITION: Compression of lhe median N. inside lhe carpal tunnel under lhe Flexor Relinaculum

M Medial ) Pisiforrn, hamaleV Lale,al') Scaphoid , Trapeziurn

Palmar culaneous Br. Of Ulnar N.Palmar culaneous Br. Of Median N.@gM Tendon of Palmaris longus

Primarg: ldiopathicSecondarg lo' Mgxedema. lheurnatoid arthriiis. Colle's fr.. $caphoid Fr.C TNTIUHCilNE:

9YMPIOMS:- EARLY (pain on the hand along the hand & Lateral 3 fingers- LAIE (Weakness, Paraslhesia, NumbnessSIGNS: As Median N. injurg al wrisl bul..(Palmar culaneous br. O{ median N. passes superficial)

Division of Flexor relinaculumMulli-vilarnins

2Ulnar + 2Palmar


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Paralgsis of harnstringsWEAK FTEXION OF KNEE

1e4-1Mrr. &uro- ,urd?ry ?l{& | 71

or Aulonornic. Palpable Neurorna. Tinel's sr8nwANESIHESIABELOW KNEEParalgsis of All Leg Ms

Paralg esIII

ANESIHESIAovER EE

clawing of toes, anesthesiabelow knee excepl media! side.INVE8ilOAflON8. IT[:

lnjurg ie common al if

OIHB!3. Aulonornic. PalpableNeuroma

. Tinel's srgn


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relAneslhesia of Whole U[ excepl :M Media! side of arm lT2)M Skin over Upper part of

Delroid (C4)

(Wailer's lip position)Aneslhesia

M Shoulder dislocalionM Direcl blow lo shoulder

CompleleClaw hand

Along Medial aspeci of& Medial 3&l/2 {in

EtrEI@@Failure of abducfion From l5o- 9OoS


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fo+i+( diiJ{

u ?ftqY t

r:rl(Ja

Diffuse hemaloma . Hernaloma lirniled tosulure liner DD: Subgleal Colleclions . DD: DepressefS{Localized cgstic

swelling in the $Cfraclure

Cul wound in Scalp causesSEVERE BTEEDING(8oalp is verg vasoular &O4

{ibrous lissues prevenl recoil)

1.1lol,t g r-tlgLDi

!ncomprehensibleSounds

Exlension lopainful slimulus,flNl ^,1eDe-cerebrate

Flexion topainful slimulusdlbl\.,1eDe-oorlicafe

C5>Delloid(shoulder movemenl, raise arm)C6> Biceps (Flexion of Elbow)C7>Triceps (extends Elbow, wrisl)C8> Wrisl, small muscles Of handL4> Quadriceps femoris (Exlension of leg al knees)


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, lvorgosteorna(Frontalsinus)

. PRIMARY:- Osteosarcorna- Fibrosarcoma- Multiple Mgelorna- Gianl cell lumor, SECONDARY:

. BENIGN:- Liporna- Papilloma- Plexiform Neuro{ibrorna- Heman$orna- Cirsoid Aneurgsm. LOCALLY MALIGNANT:Basal cell carcinorna. MALIGNANT:- Epithelioma- Melanorna- Fibrosarcorna- SebaceousAdenocarcinoma- Melaslasis

ilF-4'40}\r.

, Thgroid,Adrenal,Kidneg,Proslate

. G----. M--. N-

. E-. AN-. M-


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ilP$4)arr' &uro- )urbQ\ ?lQ7 t AMl.l'lUMo S. ETIOIOGY: UNKOWN- Exposure to radiation- Genelic (Lu Frirnani $, Neurofibromalosis, Turcof's $)Hormone replacemenl lherapgHead injuries

. CER.EBML HEMISPHERES ;Fronlal, Pafielal Tempora!, Occipital. CEREBELTO-PONIINE ANGLE TUMORS- lpsilaieral cerebellar alaxia- tpsilaleral Affeclion of Srh, 7h , 8ft N.- Conlralaleral Herniparesis. PITUITARY TUMORS:- HORMONAT MANIFESIAIIONS- Neurological manifeslations, 4lCT- Bi-lemporal Hemi-anopia. INVESTIGATIONS

MR.t...CL ScanPlain X-rag:(Separafion of cranial sufures, Bealen Silver appearance , Enlargernentof Sella furcica, Rarefaclion & deslruclion of the dorsum sellae &poslerior clinoids, Encroachmenl on the sphenoid air sinus)- Cerebral angioglaphu

TREAIMENT:- MDICAL SURGERY:o For BENIGN SUPER.FICIAL TUMORSo Palienls with signs of compression (After urgent Preoperative dehgdrafion)o Palienls with hgdrocephalus- PALIATIVE TREATMENT:

(dehgdrating measures, debulking. chemotherapg, radiolherapg, sgmplomalic lrealmenl).',t-,o Deep Turnors, Malignant infillralive lumors, Residual, Recurrenl lumors. Mosl common Brain lumor are SECONDARIES. Mosl commoh Prirnarg Brain lumor > GLIOMA

. CLINICAL PICTURE(Dull aching, Peak al mornin!,

obg cough, Straining). VOMITING:(Projectile, 4 ln morning, Nol relaled IoMeals, Nol Preceded bg Nausea. PAPILTEDEMA. FAISE LOCATIZING SIGNS:- Venlricular dilalalion- Cranial N. Paralgsis (Vl)- Herniafion $

. 2nd Mosl common Prirnarg Brain lumor> MENINGIOMA


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aRq-Toa.t . t la

ETIOTOGY'@ E.X. ) Comptession Fr., Bursl Fr., Whiplash injurga

Metabolic (OSTEOPROSI9) , Deslruclive (POIT'S DIS)CLINICAT PICTURE. Hisloru of lrauma, Pain, Swelli. O/E: Palpalion of spine shows.@lschemiaofspinaloordduelohgperflexion.hgperexlensionoflheneck

in an injured palienl. BROWN SEQUARD SYNDROME: lpsilaleral Molor loss * Conlralaleral Sensorg lossCOMPTICATONS

I) Loss of vascular tone, bradgcardia2) Loss of muscular tone ) Hgpovolemia & HgeINVESTIOATIONg. DIAGNOSIS) Plain x-rag spine, AP, laleral, odonloid. COMPLICATIONS) CT, MRITREAIMENT. ABCD+ Fixalion ol spine. Primarg surueg (....), seoondarg surveg (..,). Delinilive lrealmenl :l) tf stable )Exlernal fixalion (e.x. Plaslic collar, shoulder spica)2) lf Unstable ) Decompression, inlernal lixalion

ETIOTOGY. ORGANISM) Gram*ve, Gram -ve, anaetobic ...etc. ROUTE )Direct spread, blood spread. PDF> lrnmunocompromized patient, sePtic focus, posl-lraumaticCIINICAL PICIURE Oror;i 3. INFECTION ......... FAHM. Tachgcardia. MASS......... 4tCP. lN BRAIN lrrilalion, deslruclionINVESIIGAIIONS. LABORAIORY .......... MDIOLOGICAL.........TR,EATMENI

HgperintesitgAWBC, AESR

' Hospilalizalion , life support )Surgica! drainage (Aspiration, excision). lf small abscess (


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DEFINITION: Failure of Felus spine lo close properlgl"r monlh of

MENINGEOCELE. Bulging of meninges through spinal defecls. NO nervous lissue' SWELLINO:- site) Lumbo-scral , back of neck- Consislencg) Cgslic- Translucenl- Compressible- Expansile impulse on cough. III ) Repair during firsi few monlhs of lifeMENINGEO- MYETOCELE

I. Prolrusion of spinal cord through spinaldefecls. Dilated UB, palulous anus' Associated anomalies ) Hgdrocephalus,Arnold chiari. TMNS IILUMINAIION TEST) Dark. TTT) REPAIR AS SOON AS POSSIBLEWITHIN 24-44 HOURB

MYELOCELE. lncornpalible with lifeSYRINGOMYELOCELE. Dilation

. Mosllg Asgmptomalic till pubertg(Sorne cases Present with

Urinarg inconlinence). TTT ) NOT REQUIREDlf lhere's Neurological affeclion)Culling The MEMBRANA-REUNIENS

(Fibrous band connecting skin lo meninges)

. Folic acid deliciencg. Posilive familg hislorg. Having a babg wilhNeural lube defecis. Poorlg conlrolled DM

, PRE-NAIAL:Malernal serum Alpha-fetoprolein al 2d lffiq. POST-NAIAI:

l) l{ rnild> X-rag2) lf severe) MRI, Cf scan3) lf associaied hgdrocele > CT som,


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ilP4-4wrr. &uro- TurbQ\ ?AhY t A+DlsgEFINITION: Ruplure of annulus {ibrosis+ hernialion of nucleus pulposus

80% LUMBAR(Lo,L, - L5,S,) 20% CERVICAL(cu,c6 - c.,cr)TYPES. LATEML) Unilaleral. CENIRAL) BilaleralMOTOR. LMNL> Weakness, paralgsis in Lower

limbsSENSORY. Radicular pain , relerred lo lower limbs. Hgpothesia. Loss of superficial, deep sensalionsAUIONOMIC. Sphincleric disturbances. Vasomolor chanlles

WPESLATERAL:. Anlerior rooi) LMNL' Poslerior rool) Pain, paraslhesiaCENIRAT:' PYMMIDAL TRACT) UMNI below level. SPINOIHALAMIC TRACT) Super{icial

Sensorg loss. POST COLOUMN )Deep sensorg loss

INVESIIGAIIONS. MRr (OF CHOTCE). CT scan. Plain x-rauTREAIMENILATERAL. Conservalive )(Rest, NSAIDS, Ms. Relaxants, phgsiotherapg ..). SURGICAI) According lo pain, molor,

sensorg lossCENTRAL

TREAIMENT. Neck collar. Analgesics. Urgenl decompression

. Full-lamineclorng. Hemi-lamineclog. Micro-larnineclog


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5UEq-4wNr. &uro- turdzry ?hhY r tM

ET!OLOGY:- ORGANISM: Pgogenic ortanisrns- ROUIE: Hemalogenous alongcommunicating veins,Endogenous infections

- PDF: V lmmunitg, DANGER,- ZONEOF IHEFACE

$l'loctTHrcMBOslSDEFINITION: ln{lammalion with Thrombosis of cavernous sinus/oCtlNlCAt PICTURE: As Ang infeclion * ......l- Severe Supraorbital pain(ophthalmic branch of 5'h C.N.)2-Ederna over Masloid bone(Thrombosis of Mastoid emissarg veins)3-Proptosis4-Pupil Dilalation, Iotal Ophthalmoplegia(occutar motor nerves: gd,4'h,6* N.)

----F5- Fundal changes: papilledema, engorgernent of retinal veinsTREAIMENT:. HOSPITALIZATION IN ICU- Resl, Tonics, Analgesics- Massive doses ofsgsiemic anlibiolics- Anlicoagulants- Corneal proteclion. TTT. OF COMPLICAIIONS


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V@

Head & Spine injuries:E POND FRACTURE: is a simple depressedfraclure in children in which lhe bone is usuallginden{ed rather lhan fiaclured ,Dura usuallg intacl and this tgpe of fraclureusuallg correcls ilself bg lime wilh growlhof the skulllnvesligalion of Choice in a head lraurna wilhallered level of consciousness )CT scanBest TTT Bleeding fiom wounds or incision ofScalp )EI ln prolonged A|CT is lhe mosl affecled Nerve(Thin, runs a long course in Cranial cavilg)M Emergencg reduclion of^rcT)Iml@trEEI S'rgns of Fraclure of Poslerior Cranial fossa

M Cerebro-spinal Olorrh [@tEbone fraclureM Spinal Cord injurg is suspecled wifh:O Viclim of Signi{icanl lraumaO Pain ,lenderness of Neck, AbdominalRespiralion, PriapismM Oplic nerve usuallg escape in case of anleriorcranial fossa injurg as it is prolecled bg thebong canal {opfic canal}@ l2lh cranial nerve usuallg nol injured inposlerior cranial fossa injurg as il presenls inthe condgloid foramen and protecled bg lhecondglar processEI ln fraclure base of lhe skull :usuallg a {issureone which runs lhrough lhe weak poinls

Nenae.i4Juries:M Pseudomolor affeclion= Loss of Gland aclivilies"Anhgdrosis"M Superficial peroneal N. is responsible forsensalion in 1"r,2"d,3d loesM Ssmpathectomg cti,e in l[!![t!![M Accessorg N.) Sfernomasloid Ms.

M Complete claw hand occurs in:- klumpkes palsg- Coslo-clavicular $- Combined ulnar &median nerve injurg- Volkmanns ischemic conlraclure,- Dupuglren's conlraclure, posl-burn scatconlraclureEI fhe result of nerve is belter in pure molor nerveconlrolling lhe coarse movemenl e.g: radial & iswors{ in mixed nerve e.g: ulnar &medianE Rool of origin of- Radial netve: C5,6,7,8 &Tl- Median nerve: C5,6,7,8&Tl- Ulnar nerve: C7,8,fl

{P(}-Toqn . &uro- lurbe\ ?ffi t tAo

Turnorg:M Mosl Cornmon Melaslalic lesion involvingSpine isE Herniation of Uncus of Temporal lobelhrough len{orial nolch)Pressure on I@)Dilated {ixed pupils

EI Hernialion of Cerebellar Tonsils inlo ForamenMagnum in midbrain )Respiralorgirregularitg, loss of consciousness, Necksliffness, Head tiltM Tumors associaled wilh Neuro-{ibromalosis :O Acouslic neuromaO GliomaO MeningiomaO PheochromocglomaE Acouslic NeuromaO Arise fiom Neuromuscular lemma ofAcouslic N.O Bilaleral, Associaled with "Caf6 au lailpalches"O Grows slowlg in Cerbelloponline angleO Mag cause cerebral & pgramidal signs

Miscellaneous:E Skin Manifeslalions of Spina Bifida Occultainclude :O Tuft of hairO $kin dimpleO Skin HemangiomaM Mosl c rolapsed Lumbardisc )M The mosl imporlanl cover lo lhe brain isDUM Mattet


110/157

ilB+TWri. sleur6- ilryry ?W. W

Give a shorl accounl on Glasgow corna scaleGive a shorl accounl on depressed fraclure of skull" C/P, lnvesligalions and rnanagernenl " ( kasr2@A )

- A--- grs old bog resenled lo lhe ernergencg roorn with historg of fallfrom heighf. He was cornalosed with stable vilal signs and had clearfluid coming oul frorn his nose.- Whal's gour diagnosis? Describe the rest of the ClP and TTI of thiscondition ?( kasn2W )- Diagnosis of exlradura! hernaloma, Trealrnenl( kasn 2@720/- E u s/ans, 2@22@52@72Ob -5u slams, 2@2. 2@52fu -

,4r'ar f/@Z 2@6ZM - Ar'rar .L|, zo/zzruz@7zoo6, 2@4Aoo2zw -Ay'rar f,2M- ,4zrar rllzobzwzurzoa,2@42@2zw )- Describe clinical piclure of cutting Ulnail Radial / median nerve atwrist / elbow (5rh shams,2M [email protected] - Alrar f,[email protected]@42O2 )- Clinical Picture , investigalions and ftt of carpal lunnel sgndrome( r4y'rarf,2M)- Spinal Canal Compression( r4y'rar f,2d2)

( kasn2@8 )


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1.)EtiAw\r. &uro- turffry ?lh7 t DA


112/157


113/157

ilPq-1)qrr.futottc, ,uW\ ?htfi t lD

. BURTIS. SI$JICLOSIJRE

. S0FTTISSUESARCOI,IA. TESTHETICSIJRGEff. BEDSORES. PIGIIEilIED SI$[I LESIOTIS. lrulGMtIT [tlEl.[tl0triA' il0lI-IIEI.f,il0TIC S!fl ll TUIIIORS. TOIIGIJE ULCERS. CAIICERTO]IGUE. SWELLIT{GSOFTHEJAH, CLEFT LIP ATID CLEFT PAI.ATE. TiFCELIIilEOIIS TOPICS


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E.x. Sunburns gura,rfuJl dgFtr Affects Epiderrnistr Blislers surrounded bgerglhemaE 9urface is MoislE Painful, sensilive lo airEl Heais @EffiOFBOFhUSa@onon{Gro el$EhlT3

E.x. Uilrl hil! 1,Id 1's,"r,l1il! d9J:tr Affects Epidermis [[EE!@EI Moist, ergthemalousE Painful, sensilive lo airtr Heats E .. bg epidermalregeneralioh from remenants of swealglands provided that there's no in{eclion

18 o/o jltl e 9o/o glf J5 s.r,,i!l

CHITDREN ADULI CHITDREN< lO% Total < 15% Iotalbodg surface bodg surfacearea atea

5)Fq400\rDefinilion:Necrosis of lis

I

trtrtrtr@ofWhite or blackffi . s

ADUTTt5,- 30 %Total bodgsurtace area

wlApn> SOToIotal bodgsurtace area


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CoMffioFBORnUSsHoct< see Later/\/\Z \MorFqrcHol,clcAt

. Mag be complicaled bgseplicemia, seplicshook

. fff) wound care(See later)

@NsrRlaflilgECIIAFS. ln deep circumfereniialburns of limbsr fJf;Urgenl escharolomg

ilEq41qrr

sk FaAnoN. ln burns of face &Neck) edema. TTT:Urgenl iracheoslomg@ilpAnraErtr

Due lo edema of 8C liss:: See Orthopedics eurgsru


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SrSrEMtcdoMucttnotE oF. lrnmediate) Asphgxia. Earlg ) Pneumolhorax, pneumonia,

pulmonarg Embolism. Lale) Respiralorg failure tgpe ll (ARDS)

. IMMEDIAIE)Neurogenic shock. EARTY) Hgpovolemic shock. [ATE(>lweek)) Septic shock

. Acule LVF. Congeslive HF. Arrhglhmia.. electrical burns' Mgocardial infarction. ADYNAMIC ILEUS: Acule gaetrlo dllatallon. CURLING ULCER:Mainlg in 2'd pafi of duodenum & treated bg

EMPERICAL Omeprazole, Anlibiolics & Antifungals. LIVER DYSFUNCIION

1'R4-{0arr

. 4Calec. ACorlis. AProlebalance

Septic. Ufl. Burn wound sepsis. Pneumonia. Seplic shock. Seplic thrombophlebilis

' ACUTE TU) ACUTE C. MYOGLOB(. ACUTE RE(Sec


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E Dlean with BetadineE Dressing with Silver sulphaOinlmenl * Vaseline GauzedressingAnalgesics & anlibioticsrepeat dressing for 2 weekstill healing

trtr

PARKITADiID,SrcFlJlorAFI..1'IDS:

.i.iril 9.t"ril tr:,i9p2 Ellcrr,iti, slgp no:.o:.9rlc2 El,ertcgE;;GEE-f4ilt tr

trCrgstalloids)Ringer Laclale El0olloids+Crystalloidstr l4glx Kg x

ilPfl-Tw$OFN

ElFor lhe lircl 4U hoursa) l"t I hours ) l/2 doseb) 2"d I hours ) U4 doseo) 3'd I hours ) l/4 dosed) ?d dag) /z ori$nal dose+O.Sml/kP% butnt area colloid

Monilor adequacg of lV fluids bg Vitalsigns & urine oulpul, Hemalocril value

E/A,l'SrcRhnot.A

trtrtrtrtrtrtrtr

STOP. DROP & ROLL(Remove Pi. fiom source ofABCDEFluids run... waler oogrni4Admission & resuscilalion (CMoniloring Vilal signs (BP,Urine oulpul ... best 30-50Lab. Tesls (CBC, KFf, LFT,Eslimale Burn size & deplhDRUGS ) Anli-lelanic lG &Anlacids (fo prevenl Curlin[

NornrnoN

percenl surfacearea SALINE+lmlxKg x percenlSurface areacotlorD+20OO mlGlucose

E ProleinstrCHO,lipidsEVilamins, lrace elemenlsERoule:. 4O %... Parentrallg

tr2"d dag) Zz dosesof the td dag

. Werghing palienl. Plasma prolein level inblood. Progressive woundhealing & ebililg tocombal infeclion

-

tr/IFmicrobialagenlDe{inilion

SileAdvanlages

ExposaseplFaceOneVReVAn


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Segment of epidermis & dermis completelg cut off fromlls blood supplg, Nulrilion Depends on DIFFUSION FROM SERUM

Donor

lndicaiionsBlrunks, thighsE Upoer arm, forearmECover large areas ofgranulalion lissueECover deep burnECover afier Malignancgreseclion

Advantages

part of

E Earlg separalion,applicalionB,I'IAKE bg graft

E Cover wide areaE Deleclion of recurrenceof malionancu

Epidermis *

Dis-advanlages

B Post-auricularB Supra-clavicular

roo{ dermisE Facial burnsBCover Palm, planlar surfaceof feelBCover Site of pressure (e.g.sole of fooll

E Liable lo Conlracture,Pigmenlalion

B V Resislance lo lraumaEV Sensalion. cosmoses

lf,B.

B Direcl closure of donor siteB Minimal conlractureI Beller sensalionE Beller cosmoses

5UB4-{00N

: ffi*y,'::T Hl'::*:H H:ffi:'J,'r breas,

Tissues to be Tranlo anolher s

B tirniled donor siteE Less TAKE bg grafiE Favourable granulalion lissueEScar al donor sile

RANDollA iio;-oe Blood supplu is

Non-analomicalA Ratio 2:l

(Excepl in face)

BI.oODSOPFI-Y

EWounE RecotrWhen

AXIATf iilrh'irrrnA Well known

Blood supplganalomicallge NO dirnensionalreslriclions

ADV\NCNr1ENr E.AF

TIS

Flaps oblainedwithin area of defecl

ThAl.ls-posmor{AuILAI>

nFarebu


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L)Pq40Ar5. fla+ltc, ,urlQry ?I,QY t wSKIN.S(!rets$orE:: See General 9urgerg ::t Sebaceous cgsle Dermoid cgstt Neurofiblomafosise Lipomat Congenilal vascularanomalies

Ai6

Squamous KeratosisBowen's diseaseXeroderma Pigrnentosa

Basal cell carcinornaSquamous cel!carcinomaMalignanl rnelanoma

At

sbrryresAncorw\e DEFINITION:Mal'rgnant Conneclive Tissue lumor arisin!in lhe exlra skeletal conneclive tissuei INCIDENCE: srh &6th decade of lifelr EIIOIOOY: Unknown bul rnag follow ...- Radialion for other rnal'rgnancies- ln palient with VON RECKTENGHAUSEN $,- On top of chronic posl masleclomg arm edema- Liposarcoma- RhabdornUosarcoma- Fibrosarcomae CLINICAL PICTURE:Painless swelling enlarging over several months(Delaged presenlalion so the lumor is large since ld presentation)O/E: Soft or firm in consislencg according to arnounl of deposited collagen

INVESTIGATIONS:

surgitoons part 3 special surgery

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