Orthopaedics and Trauma, including Neurosurgery
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh in 300 Essentials SBAs in Surgery, 2017
A 35-year-old man is involved in a head on collision at a speed of 50 mph (80 km/h). On admission, he is intubated. His blood pressure is 80/35 mmHg and heart rate is 120 bpm. Abdominal examination is unequivocal. A diagnostic peritoneal lavage (DPL) is performed. Indications for laparotomy based on DPL findings include all of the following, EXCEPT: >500 000 white blood cells/mLPresence of stoolAmylase >175 IUFrank blood on initial aspiration>100 000 red blood cells/mL
Ventricular Assistance as a Bridge to Cardiac Transplantation
Wayne E. Richenbacher in Mechanical Circulatory Support, 2020
A baseline neurologic examination is performed. Due to the potential for thromboembolic events following VAD insertion, it is helpful to identify subtle neurologic findings prior to VAD insertion. An abdominal examination is repeated. Any reported abdominal pain, distension or tenderness on abdominal palpation should prompt a work-up for ischemic gut, an occasional sequela of a low output state. The abdomen is also inspected for scars from previous abdominal surgery. Carefully choose drive line and cannulae exit site locations avoiding such scars if present. If a patient has had a previous sternotomy and cardiac operation, a lateral chest roentgenogram is reviewed to see if there is a clear space beneath the sternum (Fig. 6.1). As the patient with heart failure frequently has a distended right ventricle it is possible to injure the heart at the time of repeat sternotomy. Having said that, however, we attempt to place cannulae in the chest and avoid groin cannulation for CPB as the common femoral artery and vein will need to be cannulated at the time of VAD explantation and cardiac transplantation. If a patient has had previous open heart surgery, take time to review the old operative note to identify the location of bypass grafts, note the previous surgeon’s comments about aortic length, the presence or absence of aortic mural calcification and whether or not the pericardium was left open or closed. If a patient has had previous coronary revascularization, review the most recent cardiac catheterization to determine graft location and patency, in particular, internal mammary artery grafts which may approach the midline and be injured at the time of repeat sternotomy.
Laparoscopic Anterior Lumbar Interbody Fusion
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
It is imperative that preoperative planning is performed jointly with the access of general/laparoscopic surgeon in order to facilitate the procedure. A well-documented abdominal examination should be performed by the general surgeon to determine if any contraindications exist in performing the procedure. As referred to previously, patients who have had multiple previous transabdominal surgeries, previous abdominal mesh implant insertion, or retroperitoneal surgery may not be the appropriate candidates for laparoscopic ALIF. Patients should also undergo a preoperative mechanical large bowel preparation to empty the sigmoid colon.
Air under the diaphragm—perforation or Chilaiditi sign?
Published in Baylor University Medical Center Proceedings, 2022
Shobha Mandal, Sneha Singh, Barun Kumar Ray, Rahul Kumar Thakur, Anish Kumar Shah, Victor Kolade
Management depends on presentation. Patients with radiographic evidence of Chilaiditi sign without any symptoms do not require any further treatment. In symptomatic patients, an immediate meticulous abdominal examination is needed to rule out acute abdomen requiring surgical intervention. Initial management of patients includes conservative management like bowel rest, intravenous fluid, nausea, and pain control. An abdominal x-ray should be performed to look for signs of perforation. A CT scan of the abdomen can better visualize these signs in stable patients.11–13 For diagnosis, the patient must have the following findings on the abdominal x-ray or CT scan (erect position: abdomen): distended bowel, a depressed superior margin of the liver below the level of the left hemidiaphragm, and elevation of the right hemidiaphragm above the liver by the intestine in between.14 As it can easily be misdiagnosed as bowel perforation, patients are at high risk of unwarranted surgical interventions.1,13,15
Gastroduodenal Intussusception Due to Gastric Mucosal Prolapse Polyp in a 2-Year-Old Child
Published in Fetal and Pediatric Pathology, 2021
Mostafa Kotb, Marwa Abdelaziz, Yasmine Abdelmeguid, Ahmed Hassan, Nagwa Mashali, Yasser Saad-Eldin
A 2-year-old girl presented to our institution suffering from repeated non bilious vomiting and chest infections. She had a long history of severe anemia, for which she received blood transfusions on several occasions for treatment of anemia. On examination, she looked pale and undernourished. Abdominal examination was unremarkable. She did not show any manifestation of intestinal obstruction at the time of examination. Full blood count revealed microcytic hypochromic anemia with hemoglobin: 6 g/dL (mean:12g/dL), mean corpuscular volume (MCV): 69fl (range: 73.5–84.7 fl), mean corpuscular hemoglobin (MCH): 21 pg (range: 23.1–28.2 pg), mean corpuscular hemoglobin concentration (MCHC): 317 g/L (range: 320–355 g/L) and stool analysis was positive for occult blood. Upper GI series revealed a large filling defect in the second and third parts of the duodenum, indenting the related pyloric antrum (Figure 1). Ultrasound scan showed the typical multilayered target appearance of an intussuscepting lesion.
Recognizing and Managing Pancreaticopleural Fistulas in Children
Published in Journal of Investigative Surgery, 2022
Konstantina Dimopoulou, Anastasia Dimopoulou, Nikolaos Koliakos, Andrianos Tzortzis, Dimitra Dimopoulou, Nikolaos Zavras
On admission, a detailed clinical history should be obtained. An accurate history often reveals several previous episodes of intermittent midepigastric pain, sometimes associated with vomit and nausea, whereas in some cases, trauma or abdominal surgery is recorded. A thorough family history should also be taken in order to investigate the possibility of hereditary pancreatitis, which may progress to a chronic condition with a severe clinical course and complications [16]. If three or more patients with pancreatitis are reported in the second generation, genetic screening should be performed [17–19]. Physical examination often shows diminished breath sounds and dullness on percussion on the right or left hemithorax, or even bilateral [2,5,8,9]. On the other hand, abdominal examination is generally normal, apart from distention and mild epigastric tenderness on palpation in some cases [20–22].
Related Knowledge Centers
- Ascites
- Auscultation
- Hernia
- Rash
- Stethoscope
- Abdominal Distension
- Abdominal Cavity
- Lesion
- Physical Examination
- Stretch Marks