Surgery Shelf

• Legg-Calve-Perthes disease, or idiopathic osteonecrosis of femoral head.
• 4-10, M predominance.

Benign bony growh located on midline suture of hard palate, secondary to both genetic and env. factors.

Common in young Fs, especially Asians.

Eschar = Firm, necrotic tissue due to vascular limitation secondary to edema s/p burn.

Can cause compartment syndrome

Posterior dislocation.

• Risk factors include
• Trauma
• On biopsy shows macrophages and fat globules

Infection of submandibular and sublingual glands fron infected tooth. Can cause drooling and asphixiation. Fever, dysphagia, odynphagia, drooling.

SCC which arises within a burn wound. Can also occur from osteomyelitis, radiotherapy, venous ulcers.

• (1) Splenic laceration
• (2) Liver laceration

• Osteosarcoma
• Alk phos is elevated
• Usuallye ffects areas of high growth.
• Pain worst at night.
• Pain typically begins after trauma.

• Usually ICU patient
• Probably due to cholestasis and gall bladder ischemia leading to infection.

• Gallbladder distention
• Gallbladder wall thickening
• Pericholecystic Fluid

• Key words to look for:
• Ischemia-Reperfusion Syndrome
• Soft tissue swelling

• Pain
• Paresthesia
• Pallor
• Pulselessness
• Paresis/Paralysis

Uncomplicated: Outpatient bowel rest, oral Abx (metronidazole, cipro), observation.

• Complicated:
• Fluid collection < 3 cm = IV Abx, observation
• Fluid collection > 3 cm = CT-guided drainage, than surgical drainage and debridement if no improvement by day 5.

• Tetanus Immune globulin = Passive, temporary, immediate
• Tetanus-diphtheria toxoid = Active, prolonged, delayed

Toxoid for anyone with severe wound w/ last dose > 5 years ago.

Toxoid for any with clean minor wounds w/last dose > 10 years ago

TIG injection for anyone w/ less than 3 vaccines or unknown immune status.

• FOOSH
• Pain on radial side of wrist
• Pain in anatomic snuffbox
• Decreased grip strength
• Repeat X-Ray if initially negative

• Traumatic Deceleration Injury
• Vegetative State
• Occurs at gray white matter junctions where density difference is greatest.
• Minute punctate hemorrhages on CT

• AFNTR:
• Fever, rigors
• Immune mediated host antibodies that bind donor cells.
• Activates complement and inflammatory cytokines.

• Bilateral hip, thigh, buttock claudication
• Impotence
• Symmetric atrophy of bilateral LE 2/2 ischemia

Arterial occlusion at bifurcation of aorta into common carotids.

tagged RBC scan used to identify source of bleed in case of occult lower GI bleed

• Syxs>5 days
• Usually have phlegmon w/walled off abscess.
• Give IV Abx, Bowel rest
• Delayed Appie a few weeks later.

Brachial Plexus and Subclavian Artery

• If displaced: Open reduction and internal fixation
• Otherwise:Immobilization
• If no fracture shown, repeat in 10d.

• Somatostatin analog
• Uses:
• Acromegaly; gigantism
• Diarrhea from Carcinoid Tumor
• Bad dumping syndrome following gastrectomy

Gastrografin-contrast esophagography

• Medial Meniscus (more commonly injured than lateral meniscus):
• Popping sound and severe pain after twisting injury.
• Positive McMurray's sign: Palpable or audible snap while slowly extending the knee w/ tibial torsion.

ACL: Forceful hyperextension or deceleration injury. Anterior drawer test

PCL: "Dashboard injury" Posterior-directed force on tibia with knee flexed at 90*

MCL/LCL: Valgus/Varus stree test. MCL = Abduction; LCL= Adduction is rarely injured.

• Preschool children.
• Subluxation of head of radius at elbow. Arm held in pronation at chest.

Supinate forearm and flex elbow to reduce.

Bladder Injury: Gross hematuria, retrograde cystogram w/ post-void films.

Urethra injury: Blood at the meatus, get retrograte urethogram.

People with fat malabsoprtion (e.g. Crohn's disease) becasuse Ca+2, which usually binds oxalate and prevents it from being reabsorbed, is used up binding fat, so you get more oxalate in body.

• In addition to EtOH and cholelithiasis
• ERCP
• hypertriglyceremia

• Low suggests hypovolemia
• nL 2-15
• High suggests alternative cause, such as myocardial contusion

Try ABI pre/post exercise. Exercise can expose moderate ABI.

• Myocardial rupture = Immediate death
• Myocardial contusion = Tachy with new arrthymias, sometimes sternal fracture
• Aortic Injury/Rupture = Widened mediastinum, L hemothorax.

• Embolism = Acute pain, pulselessness, pallor
• Thrombosis = Slow, progressive narrowing with insidious onset.

• Caused by axial load (e.g. fall)
• Can lead to anterior cord syndrome with loss of pain and temp., motor control.

• Greater motor loss in UE than LE
• Bladder dysfunction & urinary retention
• Variable sensory loss below level of injury.
• Freq caused by hyperextension injury in elderly.

Esophageal Rupture/Boerhaave Syndrome -> Instrumentation in esophagus or vomiting (w/ resistance) causes pneumomediastinum

• In contrast,
• Mallory-Weiss tear = Incomplete tear at GEJ. Presents as self-limiting hematopoesis because rupture is incomplete.

>10%

• Will not transilluminate.
• More common on the L
• Dull or dragging discomfort.

Bladder Dome

Do not result from discrete injuries such as falls/trauma. Instead secondary to repeated stress. Long distance runners most commonly effected, tibia and fibula most vulnerable.

• Both in young males
• Osteosarcoma: Knee, sunburst pattern/Codman's triangle on X-ray. Risk factors: Paget's Disease; bone infarcts; radiation; familial retinoblastoma. No systemic features.

Ewing's Sarcoma: Anaplastic small blue cell malignant tumor. Onion-skin appearance on bone. Diaphysis of long bones. 11;22 translocation. Systemic features: fever; malaise; weight loss.

• Disordered bone remodeling in old people.
• Increased osteoclast and osteoblast activity.
• Results in structurally inferior woven bone throughout the body (which is bigger)

• Symptoms:
• Frequently asymptomatic
• Bowing/fracture of long bones resulting in arthritis of hip, knee.
• Frontal Bossing/ Increased hat size.
• Hearing loss due to cochlear damage from enlargement of temporal bone.
• Increase in Alk Phos and Phosphorus levels.

• Recurrent skin infections around coccyx.
• Can form sinus tracts.
• Pilonidal cysts most common in young M, esp. w/lots of body hair.

Epstein-Barr Virus

• Common in runners.
• Mechanically induced neuropathic degeneration
• Neuropathic pain radiating from 3rd and 4th toe metatarsal heads.

• Intermittent bloody discharge from one nipple,
• nL u/s and mammo bc mass is typically right under nipple.
• Benign

• Anterior: Arm in Ext. rotation abducted (more common)
• Posterior: Arm in internal rotation adducted

Brachial Artery.

psoas abscess