Surgery OSPY

SURGICAL INSTRUMENTS
Bard-parker(BP) scalpel
handle and surgical blades.
Mayo dissecting scissor
MckIndeo dissecting scissor
Suture cutting scissor
Needle holder
Tissue forceps
• Plane tissue forceps • Tooth tissue forceps
Lanes tissue forceps
Allis tissue forceps
• This instrument is used to hold tough tissue like rectus sheath.
Kocher forceps
• Used in hysterectomy . Teeth's are present at it end.
Babcock tissue forceps
• Used to hold delicate tissue like intestines, stomach,
appendix fallopian tubes.
O'Shaughnessy forceps
• Used in cholesectomy .
Sponge holder
Artery forceps
• It had long distal part(as compared to needle holding forceps)
and transverse lines are present in its inner surface.
Towel clip
Deavers retractor
• It is curved retractor and used in laparotomy.
Morris retractor
• It is 90 degree retractor. Also used in laparotomy. Give wider
space.
Richardson retractor.
• Also called semi Morris.
langenbeck retractor
• It is right angel retractor. Used in thyroid surgery or
hernioplasty.
Army navy retractor.
• Right angel on both side.
London hospital retractor
Self retaining laparotomy
retractor
• Used in prolong surgeries.
MEDICAL DEVICES
Oropharyngeal airway
nasopharyngeal airway
Laryngeal mask airway
Endotracheal tube
Cuffed ETT Non-cuffed ETT
• Used in adults. • Used in children.
Direct laryngoscope
Tracheostomy tube
I/V cannula
Butterfly cannula
CVP line set
NG-Tube
LP Needle
Two ways folly's catheter
Proctoscope
Ready-vac drain
Cheat tube with underwater
seal
T tube
• Use to explore CBD.
Suture material
Absorbable suture :
1. Catgut.

2. Vicryl
• Non-absorbable:
1. Prolene

2. Silk
CLINICAL CASES
(X-RAYS, IMAGES)
GENERAL SURGERY
Achalasia (investigation-
barium swallow)
• Patient resent with
vomiting, regurgitation.
• X-RAY shows:
Narrowing of lower part
of esophagus.
Perforated peptic ulcer
• Patient have h/O
NSAID’s use presents
with severe pain and
abdominal stiffness
• X-RAY shows: Air under
right diaphragm.
• Initial Treatment:
hospitalize the patient,
NPO, pass i/v cannula
and send emergency
blood test and start i/v
antibiotic and
omeprazole, pass NG
tube and follies catheter.
• Definitive treatment:
1. Emergency laparotomy
2. Look for perforation.
3. Close the perforation by placing omental patch over it.
4. Pass the peritoneum with normal saline
5. Place a drainage tube and close the abdomen
Intestinal obstruction.
• Patient present with pain abdomen, vomiting , abdominal
distension and constipation.
• X-RAY SHOWS: In erect (standing) multiple AIR-FLUID levels
are seen. In supine position dialed gut is seen.
• Cause: causes are
1. Intestinal stricture .
2. Volvulus.
3. Intussusception.
• TREATMENT:
• Initial treatment: (same as written in previous case)
• Definitive treatment:
1. Do a emergency laparotomy.
2. Take out the cecum , if cecum is distended then it is large
gut swelling and if it is collapsed then it is a small gut
swelling.
Cholelithiasis
• 45 years old lady
presented with abdominal
discomfort and vomiting .
ultrasound shows
• Findings: stones are
present in gallbladder and
shadowing is seen.
• Treatment: cholesectomy
ERCP
• Indications :
• DIAGNOSTIC:
• Detect obstruction in CBD.
• Detect presence any stone in
CBD.
• Take a biopsy
• Therapeutic :
• Dilate the tube.
• Remove the stones
• Stunting in patient of Ca
pancreas(terminal stage)
T tube cholangiography
• Indications:
• To check flow of content in
CBD
• To check obstruction in CBD

• t-tube removal:
• it should be removed after
7 days, by opening skin
suture and pull the tube
out.
Intestinal volvulus
• X-rays show: distended
loops twisted upon each
other.
• Initial treatment: same as
for intestinal obstruction.
• Definitive treatment:
1. do a laparotomy.
2. Undo the volvulus, and
see the viability of gut.
3. If gut is not viable dissect
the necrosis part and
anastomosis. If gut is
viable then leave and
close the abdomen .
Barium enema
• Done to see the
pathology in lower
GI tract.
Pneumothorax
• Patient presented to ER
with chest injury, he
look dysnic .
• X-RAY SHOWS: Loos of
lung marking's on right
side and right lung is
collapsed.
• treatment :
1. Needle thyrocostomy
in 2 nd intercostal space
2. Pass a chest tube and
connect it with under
water seal.
Tension pneumothorax
• Patient with RTA
presented in ER with sever
dyspnea, cyanosis his neck
vessels are engorged.
• X ray shows: There is
mediastina shift on right
side and collapsed lung on
left side.
• Treatment :
1. Needle thyrocostomy
2. Chest tube with under
water seal.
Pleural effusion
• Patient with dyspnea
presented to OPD,
• X ray show: There will be
loss of costo-phrenic angel
on effected side along with
presence of meniscus sign.
• Treatment :
1. Pass a chest tube and
drain the fluid.
2. Treat the cause.
Hydro-pneumothorax
• A traumatic patient
presented in ER with
sustained chest injury.
• X rays show: Air fluid
level is seen.
• Treatment: same as
above
Ca breast (investigation
mammography)
• 45 year old lady present
with breast lump which
was irregular in shape and
palpable axillary lymph
nodes. She also had h/o
blood stain discharge .
• Mammography shows A
diffuse mass is seen along
with area of calcification.
• Investigation: FNAC or
CORE NEEDLE BIOPSY.
• TREATMENT: modified
radical mestedectomy
(MRM) with axillary
clearance )
Fibro-adenoma breast.
• 25 years old lady
present with mobile
uniform discrete solid
swelling of breast.
• Mammography findings:
uniform focal swelling
• Investigation:
1. FNAB
2. EXISIONAL BIOPSY
• Treatment:
Quadrentectomy
Pleomorphic adenoma
• A 45 years old man presented to surgical OPD with
complains of swelling around right angel of mandible.
• Investigations:
1. FNAB
2. CT Scan
• Treatment : superficial parotidectomy
• Complication:
1. Facial nerve paralysis
2. Frey’s syndrome
3. Skin flap necrosis
4. hematoma
Multi-nodular goiter
• A 35 years old lady
present with swelling on
front of neck
• Investigation:
1. Serum t3,t4 and tsh.
2. Thyroid scan
3. FNAB.
• Treatment: subtotal
thyroidectomy.
• Complications:
1. Hemorrhage
2. Recurrent laryngeal
nerve damage.
Thyroglossal cyst
• 5 year old boy comes
with small midline
swelling which moves
with protrusion of
tongue.
• Treatment: Sistrunk
operation.
Solitary nodule thyroid
• 24 years old adult present
with a small solid swelling
around anterior neck. His
thyroid scan revealed:
• Finding: A cold nodule
• Investigation:
1. t3,t4 and tsh levels.
2. Core needle or excisional
biopsy.
• Treatment:
1. perform lobectomy along
with isthmectomy.
2. Send specimen for
histopath as frozen section.
3. If malignant cells are seen
perform subtotal
thyroidectomy .
 Venous ulcer
• 55 years old security guard
presented with ulcer of right leg .
• Area name: gaiter's area
• Investigations:
1. Venography.
2. Venous Doppler/ duplex
• Conservative management:
1. Leg raising and elevation
2. Wound dressing
• Medical Treatment:
1. Antibiotics.
2. deflon
• Surgical treatment:
1. Debridement and skin grafting
Varicose veins
• Patient presents with dilated
tortures veins in left leg.
• Clinical test:
1. Tenderburg test
2. multiple tourniquet test
3. Shaut’s test
4. Perth's test
• Investigations:
1. Venous Doppler/ duplex
2. Venography
• Treatment:
1. Elastic bandage ,
sclerotherapy
2. Tenderburg procedure ,
striping of long saphenous
vein, multiple stable
evulsions.
 Acute limb ischemia
• 55 years old smoker present
with severe pain and
numbness in left leg. On
examination there is loose of
peripheral pulses and cold
extremities.
• Investigations:
1. Doppler / duplex
• Treatment:
1. Heparin
2. Percutaneous bellowing
with fogate’s catheter for
embuloctomy.
UROLOGY
 Renal stone (X ray KUB)
• 40 years old man present with
pain in left flanks which radiated
towards back.
• Finding: stone is present in left
collecting system.
• Other investigation:
1. Urine analysis
2. CBC
3. I/v urogram
4. CT KUB
• Treatment:
1. ESWL
2. PCNL
3. Percutaneous
nephrolethotomy.
Renal stones ( i/v urogram)
• 45 years old lady present
with right flank pain .
• Findings: dilation of right
renal pelvis, along with
presence of stones.
• Treatment: as written in
previous slide.
 BPH
• 70 years old male presented
with hesitancy, poor stream
and incomplete empting of
bladder .
• Investigations:
1. Abdominal/ transurethral
ultrasound
2. Uroflowmetry
3. Urodynamic
• Treatment:
1. alpha blockers
2. TURP
3. Transvesical prostatectomy
Hydrocele
• 5 years old boy presents
with large cystic
swelling of scrotum
• Name of test: trans-
illumination test.
• Types:
1. Congenital
2. Acquired
• Investigation:
ultrasound
• Treatment:
1. Lords operation
2. Jaboulay’s operation
ORTHOPEDICS
 Shoulder dislocation
• 22 years adult present in ER
with right injury shoulder
injury, his glenoid cavity was
empty.
• Types:
1. Anterior
2. Posterior
• Complications:
1. Axillary nerve damage
2. Damage to surrounding
soft tissue
• Treatment:
1. Close reduction by
Stimson procedure our by
traction counter traction
2. Open reduction.
Supra condylar fracture
humerus
• 8 years old boy present in ER with
h/o fall on a outstretched hand
and had swelling around elbow.
• D/d:
1. elbow dislocation
2. Fracture of olecranon
3. Condylar fracture humerus
• Treatment: percutaneous K wire
fixation
• Complications:
1. Compartment syndrome
2. Damage to median, ulnar or
radial nerve
3. Damage to brachial artery
4. Volkmann ischemia /
contractures
Colles fracture
• 60 years old women
comes in ER with h/o fall
outstretched hand and
have forked shaped
deformity on wrist .
• Investigation:
1. X ray wrist AP and
LATERAL.
• Treatment:
1. closed reduction and
apply POP
Hip dislocation
• A young adult with RTA
present in ER with dash
board injuries.
• Types:
1. Anterior
2. Posterior
• Treatment;
1. Close reduction by
allies maneuver or
Stimson gravity
procedure.
2. Open reduction.
Neck of femur fracture
• Lady present in ER with
h/o fall and had enable
to move left leg.
• Classification:
1. Sub capital
2. Base-cervical
3. Trans cervical
• Treatment
1. ORIF
2. hemiarthoplasty
Osteosarcoma
• A young adult presented
with pain and swelling
around knee joint.
 Open fracture
• A young adult presented in ER
after RTA , had wound on his
leg and bone is in
communication with
environment.
• Classification: gastelo
classification on next slide.
• Management:
1. clean the wound
2. Give broad spectrum
antibiotics
3. Apply external fixator.
I Open fracture, clean wound, wound <1 cm in length

Open fracture, wound > 1 cm but < 10 cm in length   without
II extensive soft­tissue damage, flaps, avulsions

Open fracture with extensive soft­tissue laceration (>10
cm), damage, or loss or an open segmental fracture. This
III type also includes open fractures caused by farm injuries,
fractures requiring vascular repair, or fractures that have
been open for 8 hr prior to treatment

Type III fracture with adequate periosteal coverage of the
IIIA fracture bone despite the extensive soft­tissue laceration or
damage
Type III fracture with extensive soft­tissue loss and
periosteal stripping and bone damage. Usually associated
IIIB with massive contamination. Will often need further soft­
tissue coverage procedure (i.e. free or rotational flap)
Type III fracture associated with an arterial injury requiring
IIIC repair, irrespective of degree of soft­tissue injury.
NEUROSURGERY
 Extra Dural hemorrhage
• a cricketer was hit by a
ball on his head he
become unconscious for
sometime but he regain
the consciousness and
complete his game. After
some time again he
become unconscious and
bring to hospital.
• Findings on CT: a
biconvex hyper dense
opacity.
• Treatment:
1. i/v mannitol and steroids
2. Do a burr hole in skull
and drain the blood.
Sub Dural hemorrhage
• Patient had a head injury
but he is conscious and had
no complain except for pain
after 10 days he become
unconscious and presented
to hospital.
• Ct scan findings: crescent
shaped hyper dense area.
• Treatment:
1. i/v mannitol and steroids
2. Do a burr hole in skull and
drain the blood.
Hydrocephalus.
• A 10 month old child
presented with enlarged
head.
• CT scan findings: dilated
ventricles are seen.
• Types:
1. Communicating
2. Non-communicating
• Treatment :
1. VP shunt
2. VA shunt