thyroid

C cells populate which part of the lateral lobe of the thyroid ?

a- upper one-third of the lateral lobe of thyroid 
b- middle one-third of the lateral lobe of thyroid
c- lower one-third of the lateral lobe of the thyroid
d- distributed equally all over the lateral lobe of the thyroid 

answer : b . C cells populate the middle one-third of the lateral lobe of the thyroid .
( typically found scattered within thyroid follicles , inside the basal lamina but not reaching the follicle lumen .)

Read more

what are the two main arteries that supply the thyroid ?

answer : superior and inferior thyroid arteries . superior thyroid artery is a branch of the external carotid artery and the inferior thyroid artery is branch of the thyrocervical trunk .

Read more

hurthle cells

hurthle cells are seen in ?

a- hashimoto’s thyroiditis
b- follicular cell carcinoma
c- hurthle cell thyroid adenoma 
d- all the above

answer is d . all the above .

Read more

dysthyroid status

characteristic eye sign in dysthyroid status ?

a- exopthalmos
b- ptosis
c- optic neuropathy
d- myopathy

answer : a . exopthalmos .

Read more

duodenal ulcer

which of the following factors contribute to the development of duodenal ulcer ?

a- Iodine 131
b- Iodine 125
c- Technitium 99
d- Phosphorus 32 

answer : a . iodine 131 .

Read more

thyroid

which of the following is/are used in the management of thyroid malignancy?

a- Iodine 131
b- Iodine 125
c- Technitium 99
d- Phosphorus 32
e- strontium 

answer is a . Iodine 131 .

Read more

thyroid

medullary carcinoma of thyroid arises from ?

a- parafollicular cells
b- cells lining the acini
c- capsule of thyroid
d- stroma of the gland 

answer : a . parafollicular cells .

Read more

Complications of chronic pancreatitis

Complications of chronic pancreatitis

Chronic pancreatitis can produce many complications which include:

Pseudocyst formation – cyst which does not have a endothelial lining
Obstructive jaundice – due to compression of common bile duct due to fibrosis
Portal hypertension – due to splenic vein thrombosis secondary to inflammation in tail of pancreas
Duodenal obstruction – secondary to fibrosis of head of pancreas
Colonic obstruction
Malnutrition – due to defective absorption of nutrients
Diabetes mellitus – due to dysfunction of beta cells of Islets of Langerhans

Read more

Tumour in the solitary kidney – Management

Tumour in the solitary kidney – Management

Renal cell carcinoma can occur in a patient with a solitary kidney
The current recommendation is to do partial nephrectomy as long as sufficient margin of normal tissue is available
This helps to avoid the requirement of lifelong hemodialysis
Partial nephrectomy cannot be done in those with a large tumour or multiple small tumours throughout the kidney
Survival rates of upto 90% have been reported in stage I disease and upto 76% for stage III tumours with conservative surgery

Reference:
Diagnosis and Management of Cancer By Ashok Mehta, S.C. Bansal

Read more

Why is the gall bladder removed during Whipple procedure?

Why is the gall bladder removed during Whipple procedure?

Whipple procedure consists of pancreaticoduodenectomy 

followed by pancreaticojejunostomy, choledochojejunostomy and gastrojejunostomy

Since the common bile duct is attached to the jejunum, the sphincteric action of sphincter of Oddi is no longer present
Bile continuously flows from the common bile duct to the jejunum
Hence the gall bladder can no longer perform its function of storage of bile
Since gall bladder function is lost, it acts as a focus of infection if retained after surgery
Hence the gall bladder is removed during Whipple procedure

Read more

VARICOCELE

Varicocele is more commonly seen in the left side because of 3 reasons

The left testicular vein opens at a right angle to the left renal vein
The loaded sigmoid colon exerts pressure on the left testicular vein
The opening of the left testicular vein is close to the opening of the adrenal veins – hence it is exposed to action of adrenergic hormones

Read more

Factors responsible for malignant transformation in undescended testis

Factors responsible for malignant transformation in undescended testis

There is 40 times increased risk for malignant transformation in an undescended testis compared to testis located within the scrotum. The factors responsible for malignant transformation in undescended testis are:

Elevated temperature
Impairment of blood supply
Abnormal germ cell morphology
Endocrine dysfunction
Gonadal dysfunction

Read more

pulsion diverticulum

Commonest cause for pulsion diverticulum of the urinary 


bladder is?

A. Benign enlargement of prostate

B. Fibrous prostate

C. Contracture of bladder neck

D. Stricture urethra

Correct answer : Contracture of bladder neck

Read more

hypertrophic pyloric stenosis

The majority of infants vomit. Because infant vomiting is so common, it is important to differentiate between normal vomiting—as occurs in almost all infants, to some degree—and abnormal vomiting, which may be indicative of a potentially serious underlying disorder. The color of the emesis and the child's overall condition must be assessed. Vomit that looks like feeds and comes up immediately after a feeding is almost always gastroesophageal reflux. This may or may not be of concern, as described earlier. Vomiting that occurs a short while after feeding, or indeed vomiting that projects out of the baby's mouth, may be indicative of pyloric stenosis. By contrast, vomit that has any green color in it is always worrisome. This may be reflective of intestinal volvulus, an underlying infection, or some other cause of intestinal obstruction.


Clinical Manifestations :

The ability to provide timely diagnosis and treatment of infants with hypertrophic pyloric stenosis (HPS) is another milestone in the history of pediatric surgery. HPS occurs in approximately 1 in 300 live births and originally was believed to occur in first-born males between 3 and 6 weeks of age. Subsequent studies determined that this was a statistical error; investigators did not account for the incidence of first-born males as a group. However, children with HPS outside of this age range are commonly seen, and the cause of HPS has not been determined. Studies have shown that HPS is found in several generations of the same family, which suggests a familial link. Administration of erythromycin in early infancy was also thought to be linked to the subsequent development of HPS, but rates of HPS have not decreased with the decline in the use of erythromycin, so this may also have been an erroneous conclusion.

Infants with HPS present with nonbilious vomiting that becomes increasingly projectile over the course of several days to weeks. Eventually, the infant develops almost complete gastric outlet obstruction and is no longer able to tolerate even clear liquids. Despite the recurrent emesis, the child normally has a voracious appetite, which leads to a cycle of feeding and vomiting that invariably results in severe dehydration if the condition is untreated. Jaundice may occur in association with HPS, although the reason for this is unclear. Particularly perceptive caregivers will mention that the infant is passing less flatus, which provides a further clue that gastric outlet obstruction is complete.

Infants with HPS develop a hypochloremic, hypokalemic metabolic alkalosis. The urine pH is high initially but eventually drops because hydrogen ions are preferentially exchanged for sodium ions in the distal tubule of the kidney as the hypochloremia becomes severe. The diagnosis of pyloric stenosis usually can be made on physical examination by palpation of the typical "olive" in the right upper quadrant and the presence of visible gastric waves on the abdomen. When the olive cannot be palpated, ultrasonography can diagnose the condition accurately in 95% of patients.Criteria for ultrasonographic diagnosis include a channel length of greater than 16 mm and pyloric thickness of greater than 4 mm.

Treatment :

Pyloric stenosis is never a surgical emergency, although the dehydration and electrolyte abnormalities may present a medical emergency. Fluid resuscitation with correction of electrolyte abnormalities and metabolic alkalosis is essential before induction of general anesthesia for operation. For most infants, administration of fluid containing 5% dextrose and 0.45% saline with 2 to 4 mEq/kg of added potassium at a rate of approximately 150 to 175 mL/kg for 24 hours will correct the underlying deficit. It is important to ensure that the child has an adequate urine output (greater than 1 mL/kg per hour) as further evidence that rehydration has occurred.After resuscitation, a Fredet-Ramstedt pyloromyotomy is performed. The procedure may be performed using an open or laparoscopic approach. Open pyloromyotomy is performed through either an umbilical or a right upper quadrant transverse abdominal incision. The former route is cosmetically more appealing, although the transverse incision provides easier access to the antrum and pylorus. In recent years, the laparoscopic approach has gained great popularity. Two randomized trials have demonstrated that both the open and laparoscopic approaches may be performed safely with equal incidence of postoperative complications, although the cosmetic result is definitely superior after the laparoscopic approach. Whether performed using an open or laparoscopic approach, surgical treatment of pyloric stenosis involves splitting the pyloric muscle until the submucosa bulges upward. The incision begins at the pyloric vein of Mayo and extends onto the gastric antrum; it typically measures between 1 and 2 cm in length. Postoperatively, IV fluids are continued for several hours, after which an oral electrolyte solution (Pedialyte) is offered, followed by formula or breast milk, which is gradually increased to 60 mL every 3 hours. Most infants can be discharged home within 24 to 48 hours after surgery. Recently, several authors have shown that ad lib feedings are safely tolerated by the neonate and result in a shorter hospital stay.

The complications of pyloromyotomy include perforation of the mucosa (1 to 3%), bleeding, wound infection, and recurrent symptoms due to inadequate myotomy. When perforation occurs, the mucosa is repaired with a stitch that is placed to tack the mucosa down and reapproximate the serosa in the region of the tear. A nasogastric tube is left in place for 24 hours and taped securely to prevent it from reinjuring the repaired mucosa. The outcome is generally very good.


most asked question in exams

Metabolic abnomiality seen in congenital hypertrophic pyloric stenosis is

a) Hypochloremic hypokalemic metabolic alkalosis

b) Hyperchloremic hypokalemic metabolic alkalosis

c) Hypochloremic hypokalemic metabolic acidosis

d) Hyperchloremic hypokalemic metabolic acidosis

Correct answer : a) Hypochloremic hypokalemic 

metabolic alkalosis

Read more

surgery workshop -simple sutures

Steps of Simple Interrupted Suture:-
1-Small toothed forceps, such as the Addison forceps shown here, should be used to grasp the skin edges during suturing. Forceps with teeth provide a secure grasp with minimal pressure, thereby avoiding crushing of the skin edge. The forceps should be held in the first three fingers as one would hold a pen, using the first three fingers.
2-The needle holder should be held in a way that is comfortable and affords maximum control. Most surgeons grasp the needle holder by partially inserting the thumb and ring finger into the loops of the handle. Note that the index finger provides additional control and stability.
3-As a rule, the needle should be grasped at its center or perhaps 50-60% back from the pointed end. The needle should be grasped 1-2 mm from the tip of the needle holder.
4-One should avoid grasping the suture material or the distal end of the needle with the needle holder, since this will damage the suture.
5-Placement of the 1st suture is begun by grasping and slightly everting the skin edge. The right hand is rotated into pronation so that the needle will pierce the skin at a 90^o angle.
6-The needle is driven through the full thickness of the skin by rotating the needle holder (supinating). By keeping the shaft of the needle perpendicular to the skin surface at all times, one takes advantage of the needle's curvature in traversing the skin as atraumatically as possible.
7-The needle has been released and is about to be regrasped. Note that the forceps maintain their grasp, thereby preventing the needle from retracting. The right hand has been fully pronated in preparation for regrasping the needle.
8-Pronation in the previous step makes it possible to complete passage of the needle with a smooth, natural supination which rotates the needle upwards and away from the surgeon. Again, this minimizes trauma to the tissues.
9-Here the needle is being regrasped in preparation for passage through the opposite skin edge. This was traditionally done by grasping the needle with the non-dominant hand. However, given the risks of HIV and hepatitis, it is probably advisable to train yourself to use the forceps for this instead of fingers.
10-The skin edge closest to the surgeon has been grasped and everted slightly, while the right hand is pronated to "cock" the needle and position it for passage through the skin.
11-Again, the right hand is supinated in order to rotate the needle through the full thickness of the skin, keeping the shaft at a right angle to the skin surface.
12-The suture material is drawn through the skin, leaving 2-3 cm. protruding from the far skin surface. The forceps are then dropped or "palmed" so the left hand can grasp the long end in preparation for an instrument tie. Note that the needle holder is positioned between the strands over the wound.

Read more