PUZZLES IN GENERAL SURGERY (eBook)
A STUDY GUIDE (2nd Edition)
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EPUB
2020
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1. Auflage
982 Seiten
Bookbaby (Verlag)
978-1-0983-1074-5 (ISBN)
982 Seiten
Bookbaby (Verlag)
978-1-0983-1074-5 (ISBN)
Puzzles in General Surgery: A Study Guide Second Edition is more than a desk reference-it offers the critical analysis that is necessary before any surgical examination, and the concise yet thorough organization of information transforms the way surgical residents and surgeons prepare for any examination in General Surgery
Surgery is fun specialty in the entire medical filed. Books and literature are the main sources of knowledge. However, getting the knowledge from large textbooks or going through large numbers of papers is time consuming and exhausting. It is about time to change the way we get our information. The author digested tones of books, handbooks and papers and then he mixed them with his experience to produce this up-to-date and concise but thorough book. This mini textbook is a hybrid. It is thorough like a textbook, concise like a handbook, and up-to-date like an article. This book provides medical students, surgical residents, and junior surgeons all the important pieces of information they need for each surgical topic. It is easy to read and memorize. It discusses in depth all aspects of a disease in a systematic and to-the-point fashion. It provides a quick but thorough review before any surgical examination of all levels.
Surgery is fun specialty in the entire medical filed. Books and literature are the main sources of knowledge. However, getting the knowledge from large textbooks or going through large numbers of papers is time consuming and exhausting. It is about time to change the way we get our information. The author digested tones of books, handbooks and papers and then he mixed them with his experience to produce this up-to-date and concise but thorough book. This mini textbook is a hybrid. It is thorough like a textbook, concise like a handbook, and up-to-date like an article. This book provides medical students, surgical residents, and junior surgeons all the important pieces of information they need for each surgical topic. It is easy to read and memorize. It discusses in depth all aspects of a disease in a systematic and to-the-point fashion. It provides a quick but thorough review before any surgical examination of all levels.
PUZZLE 2
HEAD AND NECK
HEAD AND NECK
DISEASES OF THE HEAD AND NECK
Infection
•Nosocomial Sinusitis
◦Etiology
▪Staphylococcus (Staph) aureus, Streptococcus (Strept) and Gram negative
•Risk factor: endotracheal intubation and NGT feeding
▪Immunocompromised patients, patient with nasal polyp
•At high risk of fungal → Mucorales, Rhizopus or Aspergillus
◦Treatment: Antibiotics, drainage and treat complication
◦Complication
▪Ophthalmologic: orbital cellulites or abscess
▪CNS: abscess, meningitis, or venous thrombosis
•Pharyngitis
◦Types
▪Peritonsillar abscess
▪Supraglottitis
•Etiology: Strept., Staph. and respiratory anaerobes are common pathogens. Haemophilus influenzae (occasion)
◦Complication
▪Airway obstruction (muffled, hoarseness, drooling, stridor or sniffing position
◦Treatment: secure airway, antibiotics, and incision and drainage
Solitary Neck Mass
•General
◦2/3 Rule
▪2/3 are malignant
▪2/3 are metastatic and one-third are primary tumor
▪2/3 of metastatic tumors are from supraclavicular primary
•2/3 squamous cell carcinoma (SCC) and 2/3 are adenocarcinoma followed by lymphoma
◦General Rule
▪Patient < 20: congenital then inflammatory etiology
▪20–40: inflammatory then congenital etiology
▪> 40: cancer then inflammatory etiology
◦Beware of cystic neck mass, it could be cancerous
▪Congenital: thyroglossal cyst, branchial cyst
▪B9 tumor: Warthin’s tumor
▪Malignant: SCC and thyroid cancer
•Etiology
◦Congenital
▪Anterior triangle: branchial cleft (2nd branchial cleft cyst is the most common) abnormalities (duplicate, cyst, sinus, fistula) are the most common congenital lateral neck mass
▪Midline
•Thyroglossal cyst: most common congenital midline neck mass
•Epidermoid, dermoid and teratoma
▪Posterior triangle: vascular (hemangioma, lymphangioma) and lymphatic malformations (cystic hygroma)
◦Acquired
▪Inflammatory
•Lymphadenopathy: most common acquired neck mass. Could be due to viral (reactive) or bacterial (Staph. and Strept.)
•Granulomatous lesions: Tuberculosis (TB), sarcoidosis and fungal
▪Non-inflammatory
•Neoplastic
◦Benign
▪Thyroid: most common site for benign tumor
▪Salivary glands: pleomorphic and Warthin’s tumor
▪Lipoma, schwannoma, paraganglioma and carotid body tumors
◦Malignant
▪Thyroid cancer, salivary gland cancer, sarcoma and lymphoma
◦Secondary: LN metastases is the most common
▪> 80% from SCC of upper aerodigestive tract, 50% from adenocarcinoma of salivary gland, thyroid and melanoma
•Nonneoplastic (traumatic)
◦Hematoma, pseudoaneurysm and neuroma
•Risk Factor for Neck Malignancy
◦Smoking, alcohol, virus like human papilloma (HPV), HIV and Epstein-Barr (EBV) viruses; and immunosuppression
◦History of neck cancer, radiation and autoimmune disease (Hashimoto’s thyroiditis and Sjogren’s syndrome are associated with lymphoma)
•Presentation
◦Detailed history and examination are crucial
◦Any persistent mass > 2 cm in adults is cancerous until proven otherwise
•Diagnosis (Figure 2)
◦Always perform: ENT exam, check other LN, thyroid, salivary gland, scalp, entire skin, and abdomen for organomegaly
◦CXR, neck U/S, neck CT ± MRI
▪LN features of malignancy on CT are
•Large size > 10 mm at level-II, central necrosis, indistinct margins and presence of coalescent nodes
◦FNA for tissue diagnosis with > 90% accuracy
◦Excisional biopsy: may be needed to diagnose granulomatous disease and lymphoma
•Treatment (see Figure 2): Surgical Therapy
◦General principles
▪Always perform excision under general anesthesia
▪Posterior belly of digastric muscle
•Main landmark in neck dissection
•3 nerves emerge from beneath (lateral to medial): accessory, vagus and then hypogastric nerves
▪Nerves to watch during surgery in the neck
•Facial nerve (XII) and its trunk
◦Located in the tympanomastoid fissure close to the junction of bony and cartilaginous ear canal about 1 cm anterior and deeper to tragal point at the level of posterior belly of digastric muscle
◦Might have to dissect it in a retrograde fashion
•Marginal mandibular branch
◦Tips
▪Horizontal incision along skin crease 2 fingerbreadths below mandible
▪Create superior and inferior subplatysmal flaps
◦Preserve marginal branch (supply depressor angularis oris, quadratus labii inferioris and mentalis) of facial nerve as it courses superficial to facial vessels (ligate vessel then retract the stump to elevate the nerve with stump) beneath platysma but above deep cervical fascia
•Lingual nerve
◦It has a spiral course around the salivary duct of the mandibular gland
•Vagus nerve (X)
◦It courses within carotid sheath between the carotid artery and internal jugular vein
•Spinal accessory nerve (XI)
◦Incise the deep cervical fascia along anterior border of SCM → identify posterior belly of digastric (landmark for carotid sheath, accessory, and hypoglossal nerves)
◦Emerges behind sternomastoid muscle 2 cm above Erb’s point (where great auricular and cervical plexus nerves emerge from deep tissue then up and over the midpoint of SCM)
◦Enters the trapezius muscle 2 cm below Erb’s point
•Hypoglossal nerve (XII)
◦Courses through level I/II between external and internal carotid arteries; then passes beneath posterior belly of digastric and mylohyoid muscles. It courses beneath mandibular gland
•Phrenic nerve
◦Courses through supraclavicular fossa anterior to anterior scalene muscle; then crosses over the middle scalene muscle from lateral to medial side
•Special Considerations
◦LN metastases of unknown primary: If FNA showed
▪SCC
•Neck and chest CT + panendoscopy → if still cannot find the primary → biopsy nasopharynx, tongue base and tonsillectomy → if cannot find it → you have 2 options
◦Radiation therapy (RT): usually for LN < 2 cm followed by surgery for residual disease
◦Neck dissection: usually for LN > 2 cm followed by RT
▪Adenocarcinoma
•US of neck and neck, chest, abdomen, and pelvis CT
•Bilateral mammogram ± MRI
•Endoscopy: EGD and colonoscopy
•If cannot find the primary → neck dissection ± RT
◦It has very poor prognosis
▪Papillary cell: Thyroid, renal and breast are possible primary
▪Amyloid-like: could be medullary thyroid cancer or systemic amyloidosis
▪Melanoma
•Always ask about skin lesion or removed mole in...
| Erscheint lt. Verlag | 31.8.2020 |
|---|---|
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie |
| ISBN-10 | 1-0983-1074-8 / 1098310748 |
| ISBN-13 | 978-1-0983-1074-5 / 9781098310745 |
| Haben Sie eine Frage zum Produkt? |
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