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Surgical Specialities

Surgical Specialities

Appendicitis

Appendix is a small pouch attached to the beginning of the large intestine. Appendicitis is inflammation of the appendix. It is one of the most common causes of emergency abdominal surgery.

It usually occurs when the appendix becomes blocked by stool, a foreign object, or rarely, a tumor.

Typically, the first symptom is pain around the navel. The pain may be vague at first, but becomes increasingly sharp and severe. Patient may have reduced appetite, nausea, vomiting, and a low-grade fever. As the inflammation in the appendix increases, the pain tends to move into right lower abdomen and focuses directly above the appendix.

If the appendix ruptures, the pain may lessen briefly and patient may feel better. However, once the lining of the abdominal cavity becomes inflamed and infected (a condition called peritonitis), the pain gets worse and patient becomes sicker. The abdominal pain may be worse when walking or coughing. Patient may prefer to lie still because sudden movement causes pain.

Later symptoms include Chills, Constipation, Diarrhea, Fever, Loss of appetite, Nausea, Shaking, Vomiting.

Diagnosis of appendicitis:

History

Physical Examination

Abdominal ultrasound

Abdominal CT

Treatment:

In uncomplicated case, the appendix is removed - appendectomy.

If a CT scan shows that there is an abscess from a ruptured appendix, patient is treated for infection and appendix is removed after the infection and inflammation have gone away.

Hysterectomy

Hysterectomy is a major surgical procedure in which the uterus is removed. Many women choose hysterectomy to definitively resolve their fibroid symptoms. After hysterectomy, menstrual bleeding stops, pelvic pressure is relieved, frequent urination improves and new fibroids cannot grow. A woman can no longer become pregnant after a hysterectomy.

The ovaries are not necessarily removed during a hysterectomy. Generally, if a woman is in menopause or close to menopause, the ovaries are removed. The ovaries may also be removed if they look abnormal or if the patient wants to decrease her chance of developing ovarian cancer later in life. In premenopausal women, removal of the ovaries can cause hot flashes, vaginal dryness and other symptoms. You should discuss the pros and cons of ovarian removal with your doctor.

There are several hysterectomy surgical approaches: a vaginal hysterectomy, an abdominal hysterectomy and a laparoscopic hysterectomy. The choice of procedure will depend on the size of the uterus and several other factors.

Circumcision

Circumcision is a surgical operation that removes some skin or tissue from the genitals of a boy or girl. All forms of female circumcision are illegal in Australia. This information is only to the circumcision of boys.

At birth, most boys have a sleeve of skin covering the end of the penis. This protective sleeve is called the foreskin. During a circumcision, this sleeve of skin is cut away, exposing the glans (head) of the penis. Circumcision is sometimes done a few days after birth under local anaesthetic or with no anaesthetic. Alternatively, it can be done at several months of age in hospital with a local or general anaesthetic, or even later on in life.

If a boy is uncircumcised

At birth, the foreskin is joined to the underlying glans of the penis, so the foreskin can’t be pulled back. During childhood, the foreskin continues to cover and protect the sensitive glans. At some time during childhood for most boys, the foreskin separates from the glans and can be pulled back to expose the glans.

Once the foreskin can be easily pulled back, boys can wash underneath it while in the bath or shower. Generally, the foreskin is designed to look after itself. No special care is needed for an uncircumcised penis.

The foreskin is rich in nerve endings, and is felt to play an important role in sexual sensation and functions as boys grow older.

If a boy is circumcised

After the circumcision scar has healed, the glans will be permanently exposed. The appearance of the penis will depend on how much skin has been removed and where the cuts into the foreskin have been made. No special care is required for a circumcised penis.

Lots of parents worry about their boy’s penis, circumcised or uncircumcised. They worry that their son will feel or look different from other boys, or that his circumcision or lack of it is untidy or unusual. But boys themselves usually aren’t so bothered. An uncircumcised boy might ask a circumcised friend why he looks different, or vice versa, but it’s very unlikely to be a big issue for either of them.

Fistula

A fistula is an abnormal connection or passageway that connects two organs or vessels that do not usually connect. They can develop anywhere between an intestine and the skin, between the vagina and the rectum, and other places. Some fistulas include:

Urinary Tract Fistulas

Abnormal openings within a urinary tract organ or an abnormal connection between a urinary tract organ and another organ.

Vesicouterine fistula occurs between the bladder and the uterus.

Vesicovaginal fistula is where a hole develops between the bladder and the vagina.

Urethrovaginal fistula is between the urethra and the vagina.

Anal Fistulas

Abnormal connection between the epithelialized surface of the anal canal and the perianal skin.

Anorectal Fistula occurs between the anal canal and the skin around the anal opening.

Rectovaginal or Anovaginal Fistula occurs when a hole develops between the rectum or anus and the vagina.

Colovaginal Fistula occurs between the colon and the vagina.

Other Fistulas

Enteroenteric Fistula occurs between two parts of the intestine.

Enterocutaneous or Colocutaneous Fistula occurs between the small intestine and the skin or the colon and the skin respectively.

Left unrepaired, fistulas can be traumatic, debilitating, and can do additional harm to your body. Nerve damage, infection, and kidney failure are associated with fistulas.

Symptoms of Fistula:

Swelling around or near the anus.

Skin irritation, redness and tenderness around or near the anus.

Anal pain and swelling.

Discharge of pus or blood from the area.

Fever due to infection and pus.

Constipation and painful bowel movement.

Causes of Fistula:

Fistula is very common in men between 20 to 40 years. Anal fistulas are very painful and uncomfortable because of the discharge of pus. Some common reasons which cause fistula include:

Infection in the anal glands.

Constipation

Abscess in the large intestine

Crohn’s disease

Chronic Colitis

Corns removal

Corns are a build-up of hard skin near a bony prominence of a toe or between the toes. Some people use the terms "corns" and "calluses" interchangeably.

Corns comes in several forms. These include:

Hard corns, which are the most common type, are small, concentrated areas of hard skin, typically within a wider area of thickened skin or callous.

Soft corns are whitish or gray and are rubbery in texture. They often appear between the toes.

Seed corns are small and tend to occur on the bottom of the foot.

When corns become thick, they can be very painful. The formation of corns is generally lessened or eliminated by wearing properly fitted shoes which avoid pressure and compression of the toes. Patients are advised to avoid very high heeled, narrow shoes that push the toes forward, causing them to rub against the shoe, as well as against each other. Properly fitted shoes need to have enough toe area length, as well as a deep enough toe area in order to accommodate the patient’s foot, preventing rubbing between the shoe and the toe. People who suffer from corns are able to find some relief from use of cushion pads which help to dissipate friction and pressure over bony prominences, thus alleviating the pain of a corn. A pumice stone can be used to keep the corn thin, thus relieving pressure and pain.

Corns result when pressure from shoes rub against the toes or causes friction between the toes, causing a build up of hard tissue resulting in a painful corn. Corns may occur on the top, the side, or between the toes, depending upon where friction builds up and the body’s reaction to the friction resulting in the corn. Corns typically result in swelling, redness, and discomfort, particularly when wearing snug shoes. In diabetic patients, corns can quickly become ulcers, leading to much more serious problems.

Abscess removal

Many individuals develop infections and sometimes these infections are not adequately treated or they are missed and the result is the development of pus (Abscess). Pus collections can also occur as a result of surgery and may occur anywhere in the body. When these collections of pus are not drained, the individual continues to be sick and cannot recover. Pus collections can continue to cause systemic illness, weight loss, fever and other infections in the body. In the old days, the only way to drain pus was with surgery. The surgery to drain pus is a major undertaking. Today, image guided techniques are available which are more efficient, effective, less invasive and safer than surgery. Ct guided drainage of abscess can be done almost anywhere in the body. It can access pus pockets which can't be accessed with surgery. CT guided drainage procedures are done by a radiologist trained in invasive procedures.

Where in the body can CT guided drainage be used to drain pus?

Abscess collections can be drained almost anywhere in the body and the most common sites include:

chest cavity

abdominal cavity

retroperitoneal

pancreas, kidney, liver

beneath the diaphragm

lower pelvic

thighs

neck area

rta cases

Road Traffic accidents or RTAs are as grim as any other medical emergency and one should know how to handle it. More than 1200 accidents occur every day in India.

In case of road traffic accident, the immediate step is to call a well-equipped ambulance

If the victim is breathing, then he can be placed on his back.

If there is any visible bleeding, the area should be covered and pressed firmly.

The victim shouldn’t be given water or forced to sit.

Don’t move the victim by holding his hands and legs.

Specific care should be taken to ensure that patient’s neck doesn’t move.

In case of any visible fracture/ deformity, the area should be supported with a hard plate or board under the affected part and immobilized using a cloth or tape.

If the victim is not breathing, then a Cardiopulmonary resuscitation (CPR) is required. You can start CPR if you are trained in it.

Ensure that the ambulance is on its way.

Once the ambulance arrives, the patient should be lifted upon stretcher or stiff board. This is important as lesser the movement, the lesser are the chances of worsening the injuries. The ambulance team assesses the patient and commences appropriate resuscitative measures en-route. The Emergency Room is alerted at once to await the arrival of the injured patient.

In a contemporary ER, a rapid structured assessment of patient happens on arrival by a doctor trained in advanced trauma management. Advanced resuscitative measures are commenced promptly including arresting of hemorrhage, appropriate blood product resuscitation and a need based evaluation using CT scans and other imaging modalities.