2015
[Type the company
name]
Meenaa
[ surgery practicals ]
[Type the abstract of the document here. The abstract is typically a short summary of the contents of
the document. Type the abstract of the document here. The abstract is typically a short summary of
the contents of the document.]
SURGERY
SPECIMENS:
Laminated membranes,thick and elastic resembling onion skin.(ectocyst)
Dx :hyatid cyst
Layers:outer adventitial layer bind firmly with liver,middle ectocyst,inner germinal
epithelium(endocyst)wch contain daughter cyst
Specimen of ca of c
olon distal ileum caecum and part of ascending?
Right hemicolectomy is done .tenia coli s seen
Inv:barium enema,colonoscopy
Limited resection:done for iliocaecal tb where disease segment is removed
Specimen show thyroid gland of both lobe
Sub total tyroidectomy(usually done in MNG)
Common malignancy in thyroid:pappilary ca
Surgical tx of ca:total tyroidectomy and inv in follow up :thyroglobulin
XRAY:
Plain Xray of abd, ap view,supine,SI(conciventis ring)
Dx:dilated small bowel due to intestinal obstruction
Adhesion/obstructed hernia/stricture/intersussption
Dynamic-peristalis take place but there is block (mechanical obstruction)
Adynamic – obstruction due to loss of intestinal peristalsis due to neurogenic
cause(paralytic ileus)
Plain Xray of Abd ap view erect showing
SI(coniventis seen)
Ground glass appearance –due to fluid accumulation
3fluid levels normal-at fundus,deoudenum,caecum
Dx :dialated small bowel due to intestinal obstruction
Plain xray AP view abd erect with multiple air
pockets(air abv nd fluid below) (more than 3
pockets abnormal)
Pockets present in fundus,deudonal cap and
ilioceacal region normal
Dx:intestinal obstruction
Ap view of abdomen showing large bowel(haustrasions seen) showing
braium contrast xray
Stricture is seen(if not normal peristalis)
Dx:large bowel obstruction
Ap view,supine
Trachea and bronchus slightly shifted
4tubes:nasogastric/endotracheal/ict/carotid pulse tube
Subcutaneous surgical emphysema present on rt axilla region
Air in rt lung
Dx:tension pneumo thorax
Y still air present?tube blocked/not fully drained/not able to drain
enough air
Xray of abdomen-plain xray,ant
view,supine,smallintestine(valvualar conivantis)seen.
How u tell small intestine?center of xray + rular(conivantis)seen
Dx:dialated small bowel probably due to intestinal obstruction
DX: Air under diaphragm
Cause:intestinal perforation
Gastric ulcer , doedonal ulcer
l
XRAY of chest pa view with both domes of diaphragm erect,
trachea appear central,ribs and clavicle look normal with air
filled space in rt side(if lt side fundus of stomach).
dx-perforation of diaphragm
Cause:penetration injury/post op/perforation of bowel
From where air coming?microorg/airphagia
dx:small intestinal
obstruction
Calculus
Stricture 3-4 cm
Stricture 1-2cm
dx
Contrast xray of abd (pic upside dwn)
Contrast colangiogram is done
Percutaneous T tube(latex/pvc)
Post cholesitectomy(because removed)
Radio opaque shadow in right pelvic region(confirm by
lateral xray)
Dx – calcucli
Dd-calcification/calcified LN
Confirmed by IVP/USG
Dx:small bowel dilatation
Supine posture
INSTRUMENTS:
NASOGASTRIC/RYLE’S TUBE:
Long tube having 3marking .1st mark-enter stomach/usually passed up to 2nd mark(100CM)
40cm ge junct,50cm cavity fundus,60cm pylorus
At end of tube lead shot is present .after entering position confirmed by pushing 5ml of air and auscaltating in
epigastrium/aspirating gastric juice
Indication: decompress stomach in pyloric stenosis
Dx of GIbleed
Provide nutrition in comatose
Contraind: volvulus of stomach (imposs to pass)
Radioopaque
[Link]
matermaterial
corrugated rubber drain:
Ind: during major surgery fluid such as blood loss/anastomosis leakage are dreainOUT/dirty wound abscess
Adv:used in open cavity
Bard parker scalpel:
Surgeon [Link] to inscise skin and subcutaneous tissue
Size:
Tooth forceps:tohold skin/tear tissues
Straight artry forceps: (horizontal serrations)
Scalp artry occlusion
s
Right angle clamp : fine dissesction
Open cholestitectomy dissect common bile duct
Protect from artry injury
To dissect superior pedicle of tyroid
Straight scissors:
Cut fasia,cutting soft tissue
Straight artry forceps/mosquito
s
kocher forceps
hold tuff structures like aponeurosis,fasia,during tyroidectomy to hold strap
muscles,hystrectomy
Straight mosquito forceps: also called spencer well forceps
Used to control bleeding,used in plastic surgry
Disadv:traumatic
Sinus forceps(only forcps without rachet)
Ind:disloading loculi in abscess
s
allis forceps:
to hold tuff structures
a
babcock forceps:
holding tubular structures
appendix/common bile duct/faloppian tube
a
sponge holder clamp
to hold sponge/hold cervix
minimal trauma
Protoscopehandle+outer
sheath+plunger
Lithotomy position
To visualize distal part of anal rectum up to 8cm
Indications:stricture,hemorroids
Deevers malleable retracter:
Long handle + curved proximal end
Use:open colecystectomy
Retract colon and liver
Army navy retracter:
Absorble :catgut,vicryl
Non absorbable:silk, prolein
Malecot self retaining catheter:
To drain abscess in liver abscess and pyohydro thorax
Not used in bladder
Rubber material
Foley self retain catheter:
Use:uretral catheter
Jujunostomy
draining