Mr. Miller, a 45-year-old male with a history of alcohol abuse, presents with severe pain in the upper abdomen that radiates to the back. He also reports nausea and vomiting. His blood tests show elevated levels of amylase and lipase.

What is the most likely diagnosis for Mr. Miller's symptoms?


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#Pancreatitis
#Necrosectomy, #Pancreatectomy, or #Drainage of #pancreaticabscess
#AlcoholAbuse, #Gallstones
#lifes1

Ms. Brown, a 20-year-old female, presents with pain, redness, and swelling in the upper part of the natal cleft. She reports that the pain has worsened over the past few days and now has associated purulent discharge.

What is the most likely diagnosis for Ms. Brown's symptoms?


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#PilonidalCyst
#IncisionAndDrainage, or #ExcisionAndPrimaryClosure
#SedentaryLifestyle or #Hirsutism
#lifes1

Mr. Williams, a 35-year-old male, complains of severe pain and swelling around his anus. On examination, a fluctuant mass can be palpated at the 6 o'clock position with surrounding erythema and warmth.

What is the most likely diagnosis for Mr. Williams' symptoms?


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#PerianalAbscess
#IncisionAndDrainage
#FistulaFormation
#lifes1

A 7-year old girl is admitted after she was a restrained passenger in a T-bone motor vehicle crash with impact on her side of the car. She is tachycardic and has an acute abdomen.
At surgery, she has an isolated duodenal perforation in the second portion opposite the ampulla of Vater involving 25% of the circumference.

What is the best operative plan?

A. Primary repair of the duodenum
B. Pyloric exclusion
C. Repair the duodenum, gastrostomy, jejunostomy, and
duodenostomy
D. Duodenal diverticularization
E. Gastrojejunostomy, nasogastric decompression, nasojejunal feeding tube

ANSWER: A

The best operative plan for this 7-year old girl with an isolated duodenal perforation involving 25% of the circumference in the second portion opposite the ampulla of Vater would be to perform a primary repair of the perforation with omental patch.

The primary repair of the perforation involves suturing the edges of the perforation together to close the defect. An omental patch can then be placed over the repair to reinforce it and provide additional blood supply to the area, which can aid in healing.

In this case, it is important to address the perforation as soon as possible to prevent further complications such as peritonitis or sepsis. The use of an omental patch can also help reduce the risk of further complications and improve the chances of a successful outcome.

It is important to note that the final operative plan should be determined by the surgeon based on the patient's individual condition and surgical expertise.


Blunt injuries to the duodenum are uncommon in all ages.
They account for approximately 3 to 5% of all intraabdominal injuries. Blowout injuries after blunt trauma can occur due to the retroperitoneal fixed nature of the duodenum
and compression against the vertebral column. Five grades of duodenal injury were described in 1990 using a standardized organ injury scale .
*Advance one grade for multiple injuries up to grade III.
D1, first portion of duodenum;
D2, second portion of duodenum;
D3, third portion of duodenum;
D4, fourth portion of duodenum.

Duodenal Injury Scale (AAST-OIS).
A grade I injury is a hematoma or laceration without perforation;
a grade II laceration equates to a disruption of less than 50% of the duodenal circumference; grade III 50 to 75% circumference of D2 or 50 to 100% of D1, D3, or D4;
and
grade IV disruption more than 75% circumference of D2 involving the ampulla or distal common duct.

A grade V injury involves massive disruption of the duodenopancreatic complex or duodenal devascularization.
In a retrospective review at one institution, children with grade II, III, and IV injuries were successfully managed with primary repair, and children with grade II, III and IV injuries
repaired primarily did as well as or better than children with similar injuries managed by pyloric exclusion or gastrojejunostomy.
Duodenal diverticulization refers to suture closure of the duodenal injury, antrectomy with end-to-side gastrojejunostomy, and tube duodenostomy.
It is a complex, time-consuming procedure that is generally unnecessary. The triple tube technique of drainage is unnecessary in a grade II injury.

Pelvic Abscess Tips and Tricks /Causes/diagnosis /Treatment /surgey/Laparoscopy/Draniage/Radiology

https://twitter.com/DrATEFAHMED/status/1655606803470729216?s=19

https://www.youtube.com/watch?v=rCAtQOEyqkY

#pelvicabscess #abscess #pelvis #pelvic_abscess
#abscess #abscesso #abscessedtooth #dentalabscess #abscesses #abscessodentario #abscessdrainage #hoofabscess #abscessoanal #abscessed #perianalabscess #abscesstooth #abscessessuck #abscession #abscessopericoronario #surgery #dentistry #teeth #tooth #dentistryworld #lip #nurselife #dental #gross #veterinary #dentistasfit #tannlege #dentalinfection #dentiststory #mastitis
#herniainguinal #inguinalhernia #swelling #andreaswellinger #reduceswelling #groin
#famous_doctors #topdoctors #no1doctor #harmanns
#syndrome #shorts #Surgical_problem
#surgery #MCQS #Mrcs #medical_student_exam #Medical_Student_Exam
#No1doctor #dratef #usmle…

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A 65-year-old woman with well controlled type 2 diabetes mellitus presents with perforated appendicitis. She is taken to the operating room for exploration, drainage of intraabdominal abscess, and ileocecectomy. She is admitted to the surgical intensive care unit postoperatively in septic shock.
Overnight, she is resuscitated with 9 L crystalloid. She is now on norepinephrine and vasopressin infusions to keep her mean arterial pressure above 65 mm Hg. On postoperative day 1, she is hypoxic with pulmonary edema on chest x-ray.
Her serum potassium is 5.9 mmol/L, her serum creatinine increased from 1.5 to 5.4 mg/dL (0.4-1.3 mg/dL), her serum blood urea nitrogen is 60 mg/dL (7-20 mg/dL), her serum bicarbonate is 13 mmol/L (20-29 mmol/L), and her pH is 7.21. Her urine output is 0.3 mL/kg/hour for the last 12 hours.

What is the next step in managing her renal failure?

A. Continuous renal replacement therapy
B. Intermittent hemodialysis
C. Furosemide 80 mg intravenously
D. Dopamine infusion
E. Sodium bicarbonate infusion

ANSWER: A
Acute kidney injury in the postoperative period is associated with increased morbidity and mortality. Two classification systems were proposed in the early 2000s: the RIFLE criteria
and the Acute Kidney Injury Network (AKIN) staging system. These systems provide concise definitions of the extent of injury and prognosis. Both systems consider increases in serum creatinine, either an absolute number or an
increase from baseline, and urine output criteria. This patient had a marked increase in serum creatinine and has oliguria.
According to the RIFLE criteria, she has Failure; she is in AKIN stage III.
Additionally, she is acidemic, with a serum pH of 7.21 and bicarbonate of 13 mmol/L (20-29 mmol/L), and hyperkalemic. She also shows evidence of volume overload with hypoxemia and radiographic evidence of pulmonary
edema.
This patient has several indications for renal
replacement therapy.


Data regarding the optimal modality and timing of renal replacement therapy are conflicting. However, when patients are hemodynamically abnormal and require vasopressor support, a continuous mode of renal replacement therapy is preferred. Continuous modes require smaller volumes of
blood to be removed at a time compared with intermittent hemodialysis and are better tolerated in hypotensive patients.
A sodium bicarbonate infusion is used for patients with acidosis; however, starting a sodium bicarbonate infusion is generally not recommended until the serum pH is less than
7.15. Also, there are no data confirming any reduction in morbidity and mortality for its use in renal failure.
Aggressive diuretic therapy used in the early stages of AKI to treat volume overload and hyperkalemia is possible.
However, once a patient advances to renal failure, renal replacement therapy is the preferred modality of management. Low-dose dopamine infusions were once
erroneously thought to be renal protective via a mechanism of increased renal blood flow. There are currently no data to support the use of a dopamine infusion as prevention or
treatment of AKI.