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Surgery Presentation

Transcript: Surgery: ET's presentation to hopsital Renee Duvenage 25/06/2013 Past Medical History: * 4 months Post partum- vaginal birth * L Carpal tunnel release Family history: * Father: AMI (3rd decade) Medications: * nil * NKDA Social History: * Non Smoker * Non Drinker * Lives at home with husband and child Differentials Provisional Diagnosis: GORD Peptic Ulcer Differential Diagnosis: Pancreatitis Cholecystitis AAA Investigations Management Biliary Colic Acute Cholangitis Chronic Cholangitis Anatomy: Can you name all the structures Management: Categories: 1: Incidental : requires no managment 2: Biliary symptoms, Gallstones (U/S), no complications 3: Atypical Symptoms, Gallstones (U/S) 4: Biliary symptoms without Gallstones (U/S) Complications Outcome Definitions and Classification Examination Further History Findings Thank you Imaging U/S: multiple small mobile calculi, mildly distended, positive sonographraphic Murphy's sign. CBD was not dilated (4.6 mm). Fatty liver changes identified. http://www.sonoguide.com/GB_Video13.html Presentation FBC: Leukocytosis LFT: All mildly elevated Abdominal pain S: Epigastric O: 2/7 C: Crescendo-descrendo, Never fully remitting R: Radiating to back and up to jaw. A: Alleviated by vomiting, associated with nausea, anorexia, T: At night, after dinner E: Exacerbated by food S: ranging from 3-8/10 Observation: appears comfortable at rest, bandages over laprascopic incisions present, IV cannula in situ, and is obese. Palpation: demonstrated a tender RUQ, and Positive Murphy's sign, AA difficult to palpate Auscultation: Bowel sounds present, no respiratory findings, HSDNM Percussion: Liver 14cm, no acites Blood Work Vital Signs: * Heart Rate: 74 bpm * Blood Pressure: 131/88 mmHg * Respiratory Rate: 22 bpm * Temperature: 37.7 C PC

Surgery presentation

Transcript: Ductal Adenocarcinoma Surgical treatment? Both procedures provide adequate pain relief and quality of life after long-term follow-up with no differences regarding exocrine and endocrine function. However, short-term results favor the organ-sparing procedure.* Puestow procedure Duval US CT ERCP Pathological types Insulinoma Glucagonoma Gastrinoma Somatostatinoma VIPoma Prognosis Laparoscopic Treatment Open Abdominal pain Nausea, Vomiting Epigastric tenderness Tachycardia, Hypotension Fever Paralytic ileus Ecchymoses CT US Epidemiology teroids P A N C R E A S Distal pancreatectomy Whipple's procedure Subtotal pancreatectomy Total pancreatectomy Complications Pseudocyst Infected necrosis Abscess GI bleeding Thrombosis Analgesics Celiac plexus block Pancreatic enzyme supplements Fat-soluble vitamins Insulin may be needed Diet; No alcohol, low fat Clinical symptoms Surgical Management ge >55 Whipple's procedure Symptoms Puestow procedure Treatment G E T S M A S H E D <2% of all malignancies. Usually appears in elderly. Severe Pancreatitis Distal Pancreatectomy Pathophysiology Diagnosis RCP Causes Whipple's prcedure ugar, glucose >10 mmol/L Pseudocyst Pancreaticoenteric fistulas Diabetes Mellitus Malabsorption Pancreas carcinoma THANK YOU FOR YOUR ATTENTION yperlipidemia, hypercalcemia Minimally invasive - necrosectomy through small incision in skin or stomach Conventional - necrosectomy with simple drainage Closed - necrosectomy with closed continuous postoperative lavage Open - necrosectomy with planned staged reoperations utoimmune (PAN) Resectional rauma Nasogastic tube Nothing PO 60% pancreatic head 25% body 15% tail Surgery Presentation Diagnosis Distal pancreatectomy Cullen Sign rugs Surgical Thrombophlebitis migrans Hypercalcemia Portal hypertension Splenic vein thrombosis Hemorrhagic Treatment nzymes, LDH > 600 U/L, ASAT > 200 U/L Tumor < 3cm and no metastases No survival benefit in non-curative resections Post-op morbidity is high Symptoms Mild Alcohol eutrophilia, WBC > 15 Cholestatic jaundice CA 19-9 Diffuse scarring and strictures in the pancreatic duct Exocrine & endocrine insufficiency Drainage Resection with extended drainage Acute Complications Partial Fluids Blood tests corpion venom Pancreatitis Acute Pancreatitis Extended drainage Endoscopic or percutaneous stent insertion Bypass for duodenal obstructions Pain relief (opiates or radiotherapy) Celiac plexus infiltration Pain relief PPI H2 blocker * http://www.ncbi.nlm.nih.gov/pubmed/18471517 GET SMASHED! allstones Painless obstructive jaundice Courvoisier's sign Epigastric pain which radiates to the back and relieved by sitting forward Anorexia Diabetes mellitus Acute pancreatitis Surgical management of chronic pancreatitis: Imaging Risk factors Microvascular leakage Necrosis of fat by lipase SIRS Proteolytic destruction of parenchyma Destruction of blood vessels with hemorrhage Supportive of Severe Pancreatitis Pancreatic rest Shock with MODS ARDS Renal failure DIC Sepsis Hypocalcemia Pancreatic Tumors (Pancreatoduodenectomy) aO2 <8 kPa (<60 mmHg) thanol Symptomatic Rumpfs Diagnosis Late Secretin stimulation test Imaging (US, CT, XR, ERCP) Fecal elastase Amylase & lipase usually normal Complete Fluid resuscitation Respiratory care Cardiovascular care Pain relief Parenteral feeding Treatment of infection http://www.bhj.org/journal/2001_4301_jan/reviews_175.htm Chronic Frey's procedure Hans Beger's Pathology Partington-Rochelle procedure 12% Mortality Managed on surgical wards although surgery is not often involved Severe Blood tests PANCREAS! Early Symptoms of Mild Pancreatitis Surgical Mean survival 6 months 5-year survival <2% Imaging Medical Palliative Acute necrotizing Grey-Turner Sign Etiology Cystic fibrosis Hemochromatosis Hyperlipidemia Hyperparathyroidism by Eivind W. Aabel umps Clinical enal function, Urea > 16 mmol/L Others Smoking Alcohol Carcinogens Diabetes Chronic pancreatitis High fat diet Partington-Rochelle Bapat lbumin <32 g/L Location alcium <2 mmol/L Mid-epigastric pain Jaundice Weight loss Steatorrhea Tenderness Mass Diabetic symptoms Amylase & Lipase >3x Treatment

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