Scrub in Flashcards
- Associated with portal hypertension
- ( > 12 mmHg)
Esophageal Varices
Tributaries:
-Tributary of the portal vein
1.Left Gastric Vein
Tributaries:
-Caput Medussae
2.Periumbical Vein
Tributaries:
-Hemorrhoidal veins
3.Rectal Vein
Esophageal Varices: Vignettes
- Liver cirrhosis
- Schistosomiasis
2 types of Obstruction:
-Schistosimiasis
1.Pre-sinusoidaal Obstruction
2 types of Obstruction:
- Budd-Chiari Syndrome
- Hepatic vein thrombosis
2.Post Sinusoidal Obstruction
- Best treat for ruptured esophageal varices
- Better prognosis / outcome
- Better than sclerotherapy
Endoscopic Band Ligation
Cyanoacetate
Sclerotherapy
What layer is injected during sclerotherapy?
Submucosa
What is the most common sclerosing agent?
Tetradecyl Sulfate
Cheapest sclerosing agent?
Alcohol
Least Painful agent for Pleurodesis
TALC
What is the most critical treatment of Acute Variceal bleeding?
-Prompt Endoscopic Intervention Banding - - 85% successful
- TIPS
- Transjugular intrahepatic portosystemic Shunt
Refractory Bleeding
Type with least risk for Encephalopathy
Distal Splenorenal Shunt/ Warren Shunt
- Head
- Second part
- Whipples Procedure
Pancreatic CA
Foramen cecum
Thyroglossal Duct Remnant
Most common site of ectopic thyroid tissue
Sublingual / Base of the tongue
Esophagus epithelium
Squamous epithelium
- Adenocarcinoma
- Lower 3rd of the esophagus
Barrett’s Esophagus
Near gastroesophageal junction of the esophagus where linear tear is most common located
Mallory Weis Tear
Most common site of SCC of Esophagus
Middle 3rd of esophagus
What is the vessel clamped or occluded in Pringles Maneuver
portal vein
70%
Portal Vein
30%
Hepatic Artery
What now blood vessel supply after Pringle’s Maneuver?
Hepatic Vein
Alternate clumping Portal Vein & Hepatic Artery in total ischemic time for the liver
120 minutes
Strongest layer of the esophagus
Submucosa
Most common site of Squamous Cell Carcinoma of the Esophagus
Middle 3rd
Most common obstruction in MI
LAD / Left anterior descending
Most common benign esophageal tumor
Leiomyomas
Most Squamous Carcinoma
Leiomyomas
Pre-malignant lesions in Esophagus
- Barrett’s Esophagus
- Plummer Vinson Syndrome
- Aka Patterson-Brown-Kelly Syndrome
- Predisposed to squamous
- SCC
- Esophageal webs
- Atrophic glossitis
- Iron Deficiency Anemia
Plummer Vinson Syndrome
Most common Esophageal Hernia?
Sliding Esophageal Hernia
Most common site of Mallory Weiss Tear
- Distal lower 3rd of GEJ
- Due to forceful retching & vomiting
- alcoholic
pressure rupture of esophagus
Boerhaave’s Syndrome
- aka Upper 3rd of Esophagus
- weakest part of the esophagus
- weak spot between inferior constrictor & cricopharyngeus muscle
- most common site of esophageal perforation
- most common site of Zenker’s Diverticulum
- Rupture
Killians Triangle
Chaga’s disease
Mega Esophagus
Most Common Site of Perforation of Esophagus
Killian’s Triangle
How to diagnose Hirsprung Disease?
Deep Rectal Biopsy
Stage of Decubitus Ulcer that extends into muscle, tendon & bone?
Stage IV
Bedridden, 61 Y.O, previous stroke. She has an infected deep pressure ulcer in her sacrum. AFTER debridement & supportive treatment, the pressure ulcer can be manage with?
Gluteus Maximus Flap
Also known as Full Thickness Burns
- 3rd degree burn
- All layers of skin + entire Dermis
Left Posterior diaphragm
Bochdalek’s Hernia
Anterior
Morgagni
- Diaphragm
- Embrologic of diaphragm
- From cervical C2, C3, C4
Pleuroperitoneal / Septum Transversarium
Gold Standard for Glaucoma
Tonometry
Pre-op Bowel Prep Antibiotic
Netilmicin
Dilute sodium hypochlorite (bleach) used in contaminated wounds
Dakin Solution
Bleach + acute / vinegar
Third Solution
When you do lumbar tap
- L4 – L5
- L3 – L4
- Dura & Subarachnoid space
In between Dura Mater & Ligamentum Flavum
Epidural tap
Dermatomal level of Anus
S5
What is the most common site of obstruction in gallstone ileus?
Terminal Ileum
Which is the most frequent gastrointestinal site of Crohn’s disease
Skip lesion / Coble Stone Appearance
Ileocecal Region
What is the most appropriate donor site for grafting the skin of the hand?
Inner aspect of the arm
What is the recommended excisional margin for a 3 mm depth melanoma?
2 cm
What is the most appropriate donor site for grafting the skin of the face?
Post auricular
what is the most frequently utilized flap for head & neck reconstruction?
Deltopectoral flap
What is a Marjolin’s Ulcer
- Squamous cell carcinoma that develops in a chronic wound or ulceration
- Non-healing wound
What is the most frequent site of rupture of the appendix?
Anti-mesenteric border
Why is the left kidney preferred for donor nephrectomy?
Longer left renal vein
What is the most common surgical technique for tubal ligation in the Philippines?
Pomeroy Technique
What is ligated in Pomeroy Technique?
Isthmus
Where is the donor kidney placed?
Iliac Fossa
What is Amyand’s Hernia?
The Hernia sac contains a ruptured appendicitis
henia in Mickel’s diverticula
Littre’s hernia
Accepted sclerosant for pleural effusion?
TALC
A small thick antecubital scar from 2nd degree flame burn is constricting movement. To relieve the constriction, the appropriate procedure to refresen the scar is?
Z plasty
- most common source of extra-adrenal pheochromocytoma
- near the abdominal aorta
Organ of Zuckerkandl
metastatic disease to rectouterine pouch of Douglas
Blumer’s Shelf
mets at the ovaries
Krukenberg Tumor
Conduit of choice of CABG?
Internal Mammary Artery
What is used for cross facial Nerve Graft / Spinal Nerve Injury?
Sural Nerve
Parathyroid Ca should be resected
3.5 / 3 ½
Parathyroid Ca should be resected
- 5 / 3 ½
- Leave half – still compatible with life
Parathyroid glands Normal:
4 parathyroid glands
What ligament clamp in Pringle’s Maneuver that is less harmful?
- Hepatoduodenal ligament
- Clamping of the hepatoduodenal ligament alone is less harmful because the liver is nourished partially by backflow from the hepatic vein during clamping of the HDL
on top of the mountain, how many (much) % of the PO2 of blood?
47%
Polycythemia Vera
- at sea level, the alveolar PO2 is
104 mmHg
Polycythemia Vera
- at 20,000 feet altitutde, it falls about in anacclimatized person
40 mmHg
initial chest tube drainage
1,500 ml
chest tube drainage in succceeding hours
200 ml/hour x 4 hours
level of needle thoracostomy
5th ICS MCL / AAL
causetive agent for Red tide
Pfiesteria algal
what particle suspended in the alveoli
0.5 mm
settle in the smaller bronchioles as a result of gravitational precipitations
1.5 mm
in laryngoscopy of a patient, what is the position of vocal cord
the cords are wide open (abducted)
***the vocal cords as they are seen when looking into the glottis with a laryngoscope. during normal breathing the vocals are wide open to allow passage of air