Showing posts with label General Surgery. Show all posts
Showing posts with label General Surgery. Show all posts

Oct 10, 2013


Simple Nodular Goitre causes, diagnosis, complications and treatment

Here is an approach to Simple Nodular Goitre, in which we are going to discuss its definition, causes, complications, diagnosis (clinical picture [symptoms and signs] and investigations) and management of the disease .

Definition :

Non inflammatory, non neoplastic & non toxic enlargement of thyroid gland (euthyroid)Endemic goitre .

Causes

Fluctuation of TSH level à area of active follicle, area of inactive follicle.
Most nodules are inactive & active follicles are present in internodular tissues.

Complications of Simple Nodular Goitr

1. Pressure manifestation
2. Infection very rare
3. Carcinoma (0.5 -5%)
4. Hemorrhage
5. Cyst formation & calcification.
6. Secondary thyrotoxicosis

Clinical picture of Simple Nodular Goitre

Age & sex : ♀ 20 & 30 years.

Symptoms

1- Pain: uncommon à felt when hemorrhage occurs or late malignancy.

2- Neck swelling

3- Pressure symptoms :

i) Positional Dyspnea & cough à on trachea .

ii) Change in the voice à on Recurrent laryngeal nerve

iii) Dysphagia especially in retrosternal goitre.

iv) Black out ↑ on leaning foreword.

v) Horner’s syndrome à on sympathetic chain 

Examination

· Asymmetrical thyroid swelling, nodular & firm
· trachea may be displaced.
· May be retrosternal goitre

Investigations

1.      Total T3 & T4
2.      Free T3 & T4
3.      serum T.S.H
4.      free thyroxin index: Free T4 index = total T4 X free binding sites/100
5.    Thyroid scan
·         tracer dose of iodine is given by mouth à Estimate gland uptake 

Treatment :

Sub- total thyroidectomy

Apr 20, 2013


Factors affecting Wound Healing

This article enumerates the general and local factors that affect the process of wound healing .

General Factors affecting wound healing : 

1. Age: Healing is slowly with elderly due to decreased  Protein turn over rate.
2.Nutritional Status as
Vit A Deficiency causes decreased Epithelialization
Vit. C Deficiency causes decreased Protocollagen maturity.
Protein Deficiency causes decreased  Collagen synthesis.
Also ,Calcium Zinc, Copper and Manganese plays a minor role in wound healing,
3. Cortisone Adminiftration : as it inhibits Fibroblast  proliferation.
 4.  Irradiation : Leads to End arteritis obliterans  >>  Ischaemic wound.
5. Chronic Diseases: like Uraemia, Diabetes & Malignancy delay healing


Types of Wound Healing

This article illustrates the 4 known types of  Wound Healing

1. Healing by Primary Intention:

This occurs with clean surgical wounds, there is little amount of Granulation tissues & minimal fibrosis .

So,, The final result is a fine Iinear Scar

2. Healing by Secondary Intention.:


This occurs with septic surgical wounds, there is Marked amount of Granulation tissues &.Marked fibrosis.

So The final result is a weak ugly Scar.

3. Healing by Tertiary Intemion :

Nov 28, 2012


Acute Appendicitis Causes , Diagnosis , complications and treatment

Here we're going to illustrate how to diagnose and manage a case of Acute Appendicitis , which is a surgical emergency ?

 Aetiology


Age  : 20 - 30 yrs (If old age à suspect malignancy)
Diet High protein diet predisposes to constipation à stasis & infection.
Causative organism  : E.coli, staph, strept
Route of infection   : Lumen, rarely blood & lymph
Predisposing Factors
Obstruction  à Due to hard faeces, adhesion, kink, oxyuriasis, F.B., tumors.
Anatomical factors  à Narrow lumen, wall rich in lymphoid follicles .

Pathology

A. Acute obstructive Appendicitis (2/3 of cases)