Random Flashcards
Stages of Fracture Healing
- Bleeding into Fracture
- Inflammatory Reaction Set Up
- Cells Proliferate and Callus Formed (Early Bone and Cartilage)
- Consolidation (woven bone to stronger lamellar bone)
- Bone Remodelling Under Normal Stresses
What is a fracture?
Break in the continuity of Bone
4 Principles of Fracture Management
Resuscitation
Reduction
Restriction
Rehabilitation
Problems with Fracture Union
5 I's Infection Ischaemia Interfragmentary Movement Interposition of Soft Tissues Intercurrent Illness
3 Arches in Foot
Medial Longitudinal Arch
Lateral Longitudinal Arch
Transverse Arch
Parts of the Foot
Forefoot: Metatarsals and Phalanges
Midfoot: 5 tarsals (Navicular, Cuboid and 3 Cuniforms)
Hindfoot: Talus and Calcaneus
Which artery supplies the head of the femur?
Superior Retinacular Artery
Causes of Scoliosis
Functional vs Structural
Functional=reversible:
pain or muscle spasm, difference in leg length
Structural=irreversible:
idiopathic, injuries, infection, tumour, nerve or muscle disorders, congenital eg Spina Bifida
Carpal Bones of the Hand
8 Bones
Some Lovers Try Positions That They Cannot Handle
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapeziod, Capitate, Hamate
Causes of Erythema Nodosum
PIMPS Poisons: COCP, Penicillins, Sulphonamides Infection: TB, Strep Malignancy or Lymphoma Pregnancy Systemic: Sarcoidosis, IBD
Common Tumour Markers
19-9 Pancreatic
15-3 Breast
125 Ovarian
CEA Colorectal (better for follow up than screening)
Features of MEN1
Pituitary Adenoma
Parathyroid (Hypercalcaemia)
Pancreatic
Features of HONK
severe hyperglycaemia
dehydration and renal failure
mild/absent ketonuria
GOLD classification
Global Initiative for Obstructive Lung Disease–to tailor therapy
Airflow limitation (FEV1)
no of exacerbations per year
mMRC Dyspnoea Score
BODE Index
BMI
Obstruction: FEV1
Dyspnoea MRC Score
Exercise Capacity on 6min walk
Causes Bilateral Spastic Paraperesis
Cerebral Palsy
Trauma
MS
Cord Compression (trauma, TB, malignancy–>Dexamethasone)
Causes of Gout
Drugs: Thiazides and Cytotoxics
Drinking
Diet rich in Purines
Decreased Excretion eg Chronic Renal Failure
Death of Cells eg Leukaemia, Lymphoma, Psoriasis
Indications for vascular bypass
Short claudication distance, rest pain
Complications of a bypass
Haematoma
Distal Embolism
Thrombosis
Grafts used for bypass
Above inguinal ligament = Dacron
Below= Saphenous vein (less susceptible to infection and last longer), PTFE
What is retinitis pigmentosa?
dispersion and aggregation of retinal pigement
Light’s Criteria
Exudate if 1 or more of
Pleural Fluid Protein/Serum Protein>0.5
Pleural Fluid LDH/Serum LDH >0.6
Pleural Fluid LDH> 0.66x upper limit normal serum LDH
Indications for a lobectomy
90% bronchial cancer
bronchiectasis
COPD bullae
TB (historic surgery)
What is the mechanism behind clubbing?
chronic upregulation of prostaglandins and growth factors
Techniques for breast reconstruction
Implants
Myocutaneous flaps:
- Latissiumus Dorsi Myocutaneous flap
- Transvese Rectus Abdominis Myocutaneous Flap (TRAM)
- Deep Inferior Epigastric Perforator Flap (DIEP)
Advantages and disadvantages of implants
Advantages:
Simpler technique
Disadvantages: Cosmetic result not as good Requires plenty of available skin Lies higher than other breast Late: capsular contracture, implant leak, infection
Advantages and disadvantages of Myocutaneous flaps
Advantages:
Useful when little remaining skin or muscle
Good cosmetic result
Disadvantages:
Increased blood loss
Increased op time and complications
Use of Rectus impossible if patient has had abdo surgery
Late complications–flap necrosis and infection
Muscles of the Quadriceps
Rectus Femoris
Vastus lateralis
Vastus Medialis
Vastus Intermedius
All supplied by femoral nerve
Causes of carpal tunnel syndrome
I WRIST
Idiopathic Water eg pregnancy, hypothyroidism Radial Fracture Inflammation: RA, gout Soft tissue swelling eg lipomas, acromegaly Toxic: DM, alcohol
Causes of oral ulcers
Infective: herpes simplex, candida
Neoplastic: SCC
Aphthous: B12, Behcets, IBD
Causes knee effusion
Synovial fluid = synovitis
Pus = septic arthritis
Blood = 90% ACL rupture, PCL rupture, intrarticular fracture, meniscal tear, bleeding diathesis
Surgical management of RA knee
Synovectomy and debridement (often arthroscopic)
Removal pannus and cartilage
Supracondylar osteotomy
Total knee arthroplasty
Systemic Inflammatory Response Syndrome
Temp >38 or 90
Resp rate >20
WCC >12 or
Causes bronchiectasis
Congenital:
CF
Kartageners
Youngs
Acquired:
Post infections
Obstruction
RA, IBD
Qualities of a good screening test
Wilson’s Criteria
Important health problem Recognised latent/early symptomatic stage Recognised treatment Test is acceptable to the population Case finding should be cost effective
What is pre tibial myxoedema?
Elevated shin lesions with well defined edges and thickened orange peel appearance
1-2% of Graves
Complications of hyperthyroidism
High output cardiac failure
Thyroid storm
Fixed gaze (usually painful): surgical emergency due to risk optic nerve compression
Eye signs in Graves
Exophthalmos
Chemosis
Exposure keratitis (due to poor eye closure)
Ophthalmoplegia
Causes of an absent pulse
Acute: embolism, aortic dissection, trauma
Chronic: atherosclerosis, coarctation, Takayasu’s arteritis
Features of a VSD
thrill at LLSE
systolic murmur loudest at LLSE
causes of VSD
Congenital
Acquired: traumatic, post-operative or post-MI
Associations with VSD
Fallot’s Tetralogy
Coarctation
Patent Ductus Arteriosus
Management of VSD
Closed percutaneously or surgically
+- antihypertensive therapy if coarctation
Features of Yellow Nail Syndrome
Yellow Nail discolouration and dystrophy
lymphoedema
recurrent pleural effusions
BRONCHIECTASIS
Causes of pulmonary hypertension
Left heart disease
Lung parenchymal disease eg COPD
Pulmonary Vascular disease eg PE, pulmonary vasculitis
Hypoventilation eg Neuromuscular or Obesity
Investigations of Pulmonary Hypertension
ECG
ECHO
Gold standard= Right heart catheterisation (PA>25mmHg)
Definition of Cor Pulmonale
Right heart failure due to chronic pulmonary hypertension–> dyspnoea, syncope, fatigue
What is asthma?
episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli
General measures for asthma control
TAME Technique for inhalers Avoidance of precipitants Monitor with Peak flow diary Educate and liaise with specialist nurse, Emergency action pack
Pathology behind asthma
Acute: Mast cell- Antigen interaction leading to histamine release, bronchoconstriction, mucus plugs and mucosal swelling
Chronic: Th2 cells release interleukins resulting in mast cell, eosonophil and B cell recruitment and airway remodelling
What is Motor Neurone Disease
Progressive disease of unknown aetiology with axonal degeneration of upper and lower motor neurones
Investigations of Motor Neurone Disease
Brain and Cord MRI to exclude structural lesions
LP to exclude inflammatory cause
EMG shows acute denervation
Management of Motor Neurone Disease
MDT, Palliative Care team
Supportive for drooling (Amitryptaline), Dysphagia, Respiratory Failure, Pain, Spasticity
Specific: Riluzole= glutamatergic
Different types of Motor Neurone Disease
Amyotrophic Lateral Sclerosis (most common)
Progressive Bulbar Palsy
Progressive Muscular Atrophy (LMN signs only), better prognosis than ALS
Primary Lateral Sclerosis (mainly UMN signs)
Bulbar Palsy
diseases of nuclei of CN 9-12 in the medulla–> LMN lesions of tongue, talking and swallowing
Causes of bulbar palsy
Motor Neuron Disease
Guillain Barre
Myasthenia Gravis
Central Pontine Myelinolysis
Pseudobulbar Palsy
bilateral lesions above mid-pons–> UMN lesions of swallowing and talking
Features of pseudobulbar palsy
brisk jaw jerk
hot potato speech
spastic tongue
emotional incontinence
Causes of Pseudobulbar Palsy
MS
Motor Neurone Disease
Stroke
Cerebral Pontine Myelinolysis
Indications for Pacing
Temporary:
Asystole
Prevention/Override Arrhytmia
Prior to high risk cardio intervention
Permanent:
Heart Failure
Heart Block
Long QT syndrome
Polio
RNA virus affecting anterior horn cells–>
Asymmetric LMN paralysis with no sensory involvement. Respiratory muscle paralysis may lead to death.
Myopathy Definition
Gradual onset, symmetrical PROXIMAL weakness with preserved tendon reflexes.
Muscular Dystrophies
Duchenne’s and Becker’s
Both X linked recessive.
Duchenne’s completely non-functional dystrophin, Becker’s partly functional so present later.
Investigation= Increased CK
Causes of peripheral neuropathy
ABCDE-I Alcohol and Toxins (Isoniazid, Phenytoin) B12 deficiency Chronic Kidney Disease Diabetes Every Vasculitis Infections eg HIV, Leprosy, Lyme
Large myelinated fibres=Aalpha (proprioception loss)
Small unmyelinated fibres= C (pain and temp lost)
What is Chorea and some causes?
Non-rhythmic, purposeless, jerky, flitting movements
Huntington’s
Sydenham’s
Wilson’s
L-DOPA
What is Guillain Barre?
An acute autoimmune demyelinating polyneuropathy with symmetrical ascending flaccid weakness
Investigations and Management in GBS?
Immune serology for anti-gangleoside antibodies
Slow conduction velocities on Nerve Conduction Studies
Protein in CSF
Supportive: Airway, Analgesia, Autonomic support, Antithrombotic
Immunosuppression: IVIg, Plasma exchange
Physiotherapy
What is hereditary haemorrhagic telangiectasia?
AKA Osler Weber Rendu Syndrome
Autosomal Dominant vascular dysplasia leading to telangiectasias and AVM formations.
Can have frequent nosebleeds and at risk of haemorrhage.
Manage with transfusion +- surgical/laser ablation if acute haemorrhage. Tranexamic acid may help day to day.
What is Pemphigus Vulgaris?
Autoimmune blistering disease due to auto antibodies against desomosomes.
May be precipitated by drugs such as NSAIDs, ACEi, L-DOPA
Nikolsky Sign Positive. Mucosa is often affected and bullae rupture easily
Bullous Pemphigoid
Autoimmune blistering disease due to autoantibodies against hemidesmosomes.
Biopsy shows linear IgG along the Basement Membrane and subepidermal bullae
Treatment Pemphigus vs Pemphigoid
Pemphigus=
Predinisolone
Rituximab
IVIg
Pemphigoid=
Clobetasol (Dermovate)
What is Erythema Multiforme?
Symmetrical target lesions on palms, soles and limbs.
IgM deposition
Infections: HSV, Mycoplasma
Drugs: SNAPP (Sulphonamides, NSAIDS, Allopurinol, Penicillin, Phenytoin)
What is a keloid scar?
Overgrowth of dense fibrous tissue after injury has healed. Commoner in dark skins and tends to recur after excision.
Mx: local steroid injection, cryotherapy
Causes of parotid swellings
Diffuse swelling:
Systemic (CLD, DM, anorexia, bulimia), Infection (Parotitis), Autoimmune (Sjogren’s), Infiltration (Sarcoid)
Localised swelling:
Lipoma, Salivary gland neoplasm (benign pleiomorphic ademona 80% or malignant Warthin’s tumour), leukaemia (ALL) or calculus
Causes of Duputren’s
BIFADE Booze Idiopathic Family History (Autosomal dominant) AIDS Diabetes Melitus Epilepsy and Epilepsy Meds
Mx: Physio and Allopurinol
Surgery indicated if contracture>30 degrees. Partial fasciectomy or fasciotomy
What is a hypertrophic scar?
Arises on site of injury, excess collagen deposit.
Stays within margin and gradually fades with time.
Across flexor surfaces and skin creases.
Mx: mechanical pressure therapy, topical silicone gel sheets, intralesional steroid and LA injections
Lipoma
Benign tumour of mature adipocytes. Occur anywhere fat can expand.
Mx: Surgical excision and non-surgical
Dercum’s Disease
Multiple Painful lipomas
peripheral neuropathy
obese post-menopausal women
Sebaceous Cyst
epithelial lined cyst containing keratin occuring at sites of hair growth
Two types: epidermal or trichelemmal
Complications: infection, ulceration, calcification
What is Compartment Syndrome?
Oedema leads to increased compartment pressure and decreased venous drainage, further increasing compartment pressure.
If Compartment pressure>capillary pressure= ischaemia
Muscle infarction–> Rhabdo and ATN, fibrosis and Volkman’s ischaemic contracture
Management of Compartment Syndrome
Elevate limb
Remove all bandages and casts
Fasciotomy
Knee Ligament Repairs
Meniscal:
Arthroscopic or Open Partial Meniscectomy or Meniscal repair (predisposes to Osteoarthritis)
ACL: Autograft repair (Semitendinosus +-Gracilis)
Features of Prolactinoma
Prolactin>5000
Symptoms of amenorrhoea, infertility, galactorrhoea, mass effects from tumour
Exclude drug history (Dopamine Antagonists eg antiemetics and antipsychotics)
Management of Prolactinoma
1st: Cabergoline and Bromocriptine (Dopamine agonists)
SE–nausea, postural hypotension and lung fibrosis
2nd: transphenoidal excision
Features of Primary Hyperaldosteronism
Hypokaemia, raised BP, paraesthesia
70% bilateral adrenal hyperplasia
30% Conn’s= Adrenocortical adenoma
Management of Primary Hyperaldosteronism
Ix: Raised aldosterone:renin ratio; Adrenal CT/MRI
Conn’s laparoscopic adrenelectomy
Hyperplasia: Spironolactone, Amiloride
What is Sarcoidosis?
Multisystem granulomatous disorder of unknown cause
Non-caseating granulomas
60% resolve within 2 years
Management Sarcoid
Acute: bed rest and NSAIDs
Chronic: Steroids and additional immunosuppresion (Methotrexate, Ciclospirin, Cyclophosphamide)
Features of Sarcoid
fever, anorexia, lymphadenopathy and weight loss,
Cutaneous: erythema nodosum, lupus pernio
Polyarthralgia, Dactylitis
Increased Calcium–> Stones
Hepatomegaly, Splenomegaly
Differentials for Granulomatous Disease
Infections: TB, leprosy
Autoimmune: PBC
Vasculitis: Wegener’s, Giant Cell Arteritis
Idiopathic: Sarcoid, Crohn’s
Causes of bilateral hilar lymphadenopathy
Sarcoidosis
Infection: TB, Mycoplasma
Malignancy: Lymphoma, Carcinoma
Interstitial Disease: EAA, Silicosis
What is Behcet’s Disease?
Systemic Vasculitis of unknown cause Turks, Mediterranean, Japanese Recurrent oral and genital ulceration \+ Erythema Nodosum \+ GI features + Eye uveitis
Ix skin pathergy test (formation of papule)
Mx Immunosuppression
What is obstructive sleep apnoea?
Intermittent closure/collapse of pharyngeal airway leading to apnoeic episodes during sleep
Complications: Pulmonary hypertension
Ix Polysomnography, SpO2
Mx reduce weight, stop smoking, CPAP, surgery to relieve pharyngeal obstruction
Risk factors for Obstructive Sleep Apnoea
Obesity male Smoker Alcohol Idiopathic pulmonary fibrosis
Management Rotator Cuff Tear
Physio
Analgesia, steroid injections
Open/arthroscopic repair
Management Adhesive Capsulitis
NSAIDs, steroid or LA injection
Impingement Syndrome Management
Rest + physio
NSAIDs, bursa steroid or local anaesthetic
Arthroscopic acromioplasty
Differentials for a Painful Arc
Impingement Syndrome
Supraspinatus tear
AC joint osteoarthritis
Complications of knee arthroplasty
Immediate: Fracture Cement reaction Nerve injury to peroneal Vascular injury to SFA, popliteal or genicular
Early:
DVT
Deep infection
Late:
Loosening
Decreased range of movement and instability
Types of knee arthroplasty
Unicompartmental (one side)
Unconstrained bicompartmental= femoral, tibial, patellar
Constrained bicompartmental= for tumours, less physiological
Sclerosis
Increased bone density in subchondral layer of joint
Subchondral cyst
Well defined lyric lesion in the periarticular surface
Management for Ankylosing Spondylitis
Encourage swimming and regular exercise
Physio
NSAIDs first line
Dmards only if peripheral joint involvement
TNFalpha if severe disease, eg Etanercept and Adalimumab
Pancoast Syndrome
Invasion of thoracic inlet structures:
Cervical sympathetic plexus
Brachial plexus
Arm oedema due to blood vessel compression
Recurrent laryngeal nerve palsy
Lung mets come from
Bowel Breast Kidney Melanoma Bone
Paraneoplastic features of lung disease
SIADH Cushings Carcinoid PTHrP (small cell) Dermatomyositis
Investigations in lung cancer
- Diagnose mass: cx, ct thorax
- Determine cell type: induced sputum cytology, biopsy by bronchoscopy
- Stage
- Lung function tests for operability assessment
Contraindications for lung cancer surgery
SVC obstruction
Malignant pleural effusion
Vocal cord paralysis
FEV
Auschpitz sign
Picking skin and it bleeds (psoriasis)
Features of inguinal hernia
ABCR Above pubic tubercle Bowel sounds Cough impulse Reducible
Indications for CABG
Left stem stenosis
Triple vessel disease
Angina refractory to medication
Unsuccessful angioplasty
Complications of CABG
Thromboembolic: mi or stroke Post-perfusion syndrome Stenosis of graft Bleeding: pericardial tamponade or haemothorax Non Union of sternum Death
Pneumothorax types
Traumatic (open or closed= no defect in chest wall)
Spontaneous: primary or secondary. Primary with no underlying lung disease
Iatrogenic
Contents of carpal tunnel
Median nerve
4 tendons of Flexor Digitorum Profundis
4 tendons of Flexor Digitorum Superficialis
1 tendon Flexor Pollicis Longus
Complications of Mitral stenosis
Atrial fibrillation
Emboli
Pulmonary hypertension
Left atrium enlargement–> compression surrounding structures
Causes of Mitral Regurgitation
FARM Functional (IHD) Annular calcification Rheumatic heart disease Mitral valve prolapse
Causes of aortic regurgitation
Valve leaflet:
Endocarditis
Rheumatic fever
Aortic root:
Type A dissection
Dilatation (Marfans or hypertension)
Aortitis (syphilis or Ankylosing spondylitis)
Austin Flint murmur
Mid diastolic murmur due to regurgitant flow impeding mitral opening (found in AR)
Euroscore
Risk model for operative mortality in cardiac surgery. Takes into account Patient factors Heart factors Operation
TAVI
Transcatheter Aortic Valve Implantation
Minor Criteria for Duke’s
FIRE-almost!
Fever
Immune Phenomena: Osler nodes, Roth spots, Glom Neph
Risk Factors: IVDU
Emboli: Janeway lesions, splinter haemorrhages
Almost= Positive blood culture not meeting major criteria
Virchow’s Triad
Stasis of Blood Flow
Hypercoagulability
Endothelial Injury
Causes of AF
Cardiac:
IHD
Valve Pathology
Hypertension
Metabolic:
Hyperkalaemia
Thyrotoxicosis
Alcohol
Infection eg Pneumonia
Complications of Pacemaker
Insertion:
Bleeding
Arrhythmia
Post Insertion; Erosion Lead Migration Pocket Infection Malfunction
Causes of Heart Failure
Left:
IHD,
Systemic Hypertension
Mitral or Aortic Valve Pathology
Right:
Left Ventricular Failure
Pulmonary Hypertension
Tricuspid or Pulmonary Valve Pathology
New York Heart Failure Classification
- No Breathlessness
- Breathless with Moderate Exertion
- Breathless with Mild Exertion
- Breathless at Rest
Management for Heart Failure
First line = beta blocker + ACEi (+ Loop)
Second line = add Spironolactone/ARB
Third= Consider Digoxin
4th= Cardiac Resynchronisation
Lots of Chadsvasc and lots of Hasbled criteria met?
Consider Left Atrial Appendage Occlusion
CHA2DS2VASc
Congestive Cardiac Failure Hypertension Age over 75 Diabetes Stroke or TIA Vascular disease Age over 65 Sex is Female
Pathology behind Rheumatic Fever
Antibody cross reactivity following Strep Pyogenes infection leading to MOLECULAR MIMICRY
antibodies cross react with Myosin, Muscle Glycogen and Smooth Muscle Cells.
Formation of Aschoff bodies and Anitschkow Myocytes
Complications of Prosthetic Valves
FIBAT Failure: --Acute (dehiscence, breakage, thrombus) --Chronic (stenosis, incompetence) Infective Endocarditis (Staph Epidermidis early, Strep Pyogenes late) Bleeding Anaemia (from haemolysis or Warfarin) Thromboembolism
Management of osteoarthritis joints (surgical)
Arthroscopic washout (mainly knees, trim cartilage and remove loose bodies) Realignment osteotomy (
Posterior vs Anterior approach for hip
Posterior reflects short external rotators and gives better access but has higher dislocation rate cause Sciatic Nerve Injury
Anterior reflects abductors with incision over greater trochanter dividing fascia lata. Superior gluteal nerve may be injured
Preventing DVT in surgery
Pre op:
Ted stocking
Stop OCP
Aggressive optimisation and hydration
Intra op:
Minimise length of surgery
Pneumatic compression boots
Post op: LMWH Early mobilisation Good analgesia Adequate hydration
Indications, pros and cons of hip resurfacing
Indicated in young (
Management of bunion
Non surgical:
Appropriate footwear: wide, soft
Physio
Surgical:
Bunionectomy
1st metatarsal realignment osteotomy
Excision arthroplasty
Management of lesser toe deformities
Caused by imbalance between intrinsic and extrinsic toe muscles
Non surgical: appropriate footwear
Surgical:
Flexor to extensor tendon transfer
Arthrodesis
Resection of proximal phalangeal head
What is a Charcot joint?
Progressive destructive joint arthropathy secondary to disturbance of sensory inner action to the joint resulting in painless deformed joint due to repetitive minor trauma.
Phases of gait
Heel strike
Stance
Toe off
Swing
Bakers cyst + management
Posterior herniation of knee joint capsule,
Associated with degenerative knee joint disease
Aspirate but high recurrence
Boutonnière deformity
PIP flexion with DIP hyper extension
Swan neck deformity
DIP hyper flexion with PIP hyperextension
Z deformity of thumb
Hyperextension of interphalangeal joint with fixed flexion and subluxation of the metacarpophalangeal joint
Pathophysiology behind Dupuytren’s
Local micro vessel ischaemia leading to increased Xanthine Oxidase activity leading to ROS production.
ROS production results in Collagen 3 formation and chronic inflammation leading to continued fibrosis.
Locations of median nerve entrapment
Carpal tunnel
Deep head of pronator teres (Anterior Intraosseous Syndrome) –muscle weakness only
Causes of Boutonnière and Swan neck deformity
Boutonnière = rupture of central slip of extensor expansion
Swan= rupture of lateral slips
Bouchard vs Heberdens nodes
Heberdens at DIPs
Bouchards at PIPs
Management of ulnar nerve palsy
Non surgical:
Avoid repetitive flexion extension of elbow
Night splinting if elbow in extension
Surgical:
Ulnar nerve decompression
Medial epicondylectomy
Management of mallet finger
Splint with distal phalanx in extension for six weeks to allow tendon reattachment
If avulsed bone is large may fix it with a Kirschner wire
Trigger finger
Tendon nodule which catches on proximal side of tendon sheath causing triggering on forced extension
Causes:
Idiopathic
Trauma
Activities requiring repetitive forceful flexion
Secondary to RA
Management trigge finger
Steroid injection
Tendon release by sheath incision
Management of lumbar disc herniation
Conservative:
Max 2day bed rest
Keep active and physio (back school)
Medical: analgesia, muscle relaxant (low dose diazepam)
Surgical: if progressive neurological deficit or incapacitating pain
Permutations microdiscectomy
Endoscopic discectomy
Hemilaminotomy plus discectomy
Post Op recovery for hernia repair
Pee before leaving Early mobilisation Analgesia Avoid constipation so give Lactulose Work in 1-2 weeks Keep area clean and dry
Why do 98% of varicoceles occur on the left?
Left testicular vein more vertical
Left renal vein can be compressed by colon
Left testicular vein longer than right and lacks terminal valve to prevent back flow
Post Op recovery for hernia repair
Pee before leaving Early mobilisation Analgesia Avoid constipation so give Lactulose Work in 1-2 weeks Keep area clean and dry
Why do 98% of varicoceles occur on the left?
Left testicular vein more vertical
Left renal vein can be compressed by colon
Left testicular vein longer than right and lacks terminal valve to prevent back flow
