https://www.residentreview.org/score-calculators daily 0.75 2020-05-26 https://www.residentreview.org/fluids daily 0.75 2020-04-24 https://www.residentreview.org/home daily 1.0 2021-10-17 https://www.residentreview.org/tracheobronchial-trauma daily 0.75 2020-04-25 https://www.residentreview.org/nissen-vs-linx daily 0.75 2020-04-25 https://www.residentreview.org/nutrition daily 0.75 2020-04-25 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ea3cd6a414389445842b4f5/1587793451581/ Nutrition - Nutrition Overview Calories: Dextrose- 3.4 cal/g || Carbs- 4 cal/g || Protein- 4 cal/g || Alcohol- 7 cal/g || Fat- 9 cal/g Requirements: Calories: 20-25 cal/kg/day Protein: 1-1.5g/kg/day TPN/PPN: Central Line: Glucose based Peripheral Line: Fat based Source of fuel: Glutamine- fuel for small bowel enterocytes Short Chain Fatty Acids- Colonocytes https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ea3d209ecc98b1707975bc4/5ea3d2d88315084d6db0902d/1587794649820/Halflives.PNG Nutrition https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ea3d209ecc98b1707975bc4/5ea3d64300047c5743a580a5/1587795524773/Vitamins.PNG Nutrition https://www.residentreview.org/gallbladder daily 0.75 2020-05-04 https://www.residentreview.org/inguinal-hernia-open-or-lap daily 0.75 2020-05-01 https://www.residentreview.org/gastroduodenal-ulcers daily 0.75 2020-05-04 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb05f4dca0ca24071d5f913/1588617661885/PUD2.PNG Gastro-Duodenal Ulcers - Other Ulcer Types: Cushing – Severe head trauma, due to increased gastrin and HCl hypersecretion// How to remember Cushing was neurosurgeon, Head trauma – Cushing ulcer Curling - 30% TBSA Burns, due to mucosal ischemia // How to remember:Curling Iron Burns – Curling ulcer Cameron’s -typically linear ulcerations by the GE junction, secondary to a diaphragmatic compression on the stomach. Occurs in the setting of a hiatal hernia Marginal Ulcer- ulcer’s found in the gastro-jejunostomy, typically secondary to lack of Brunner’s glands in the Jejunum It’s bleeding! •Dx/Tx: reverse anticoagulation, EGD w/ adjuncts •Active pulsatile bleeding and visible vessel are highest re-bleeding risks •If liver failure and from esophageal varices --> EGD w/ banding, TIPS if local therapy fails •If unable to find source --> angiography --> tagged RBC scan •Gastric varices w/o esophageal varices – hx of pancreatitis – think splenic vein thrombosis. Dx with US. For symptomatic pts ---> splenectomy https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb059b04b525e14b5be2e6e/1588615617939/pud1.PNG Gastro-Duodenal Ulcers - Peptic Ulcers H. pylori infection is the number 1 risk factor for peptic ulcers •MCC: H. pylori, followed by NSAIDs •H. Pylori Tx – PPI, Amoxicillin with Clarithromycin or Metronidazole (‘CAP’ or ‘CAMO’) •Confirm eradication with urea breath test •Presents with bleeding – ALWAYS EGD with some adjunct •Indications for surgery: perforation, bleeding despite endoscopic therapy, obstruction https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb0659112cd060d82fee12b/1588618656202/pud3.PNG Gastro-Duodenal Ulcers Surgical Options: •Perforated GASTRIC ulcer- antrectomy with truncal vagotomy (RISK OF GI CA) •Perforated DUODENAL ulcer – graham patch or if bleeding duodenotomy w/ GDA ligation •Highly selective vagotomy – highest ulcer recurrence rate https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb065b5651ee31d5f016767/1588618690499/pud4.PNG Gastro-Duodenal Ulcers •Best reconstruction is RY – less dumping syndrome and bile reflux •Always send ulcer tissue to path https://www.residentreview.org/quick-guide daily 0.75 2020-05-04 https://www.residentreview.org/paraesophageal-and-diaphragmatic-hernias daily 0.75 2020-05-07 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb3829a1baec80e3ab24415/1588822714035/hh1.PNG Para-esophageal and Diaphragmatic Hernias General Diaphragmatic and Hiatal Anatomy https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb38317d47d294536783828/1588822838984/hh2.PNG Para-esophageal and Diaphragmatic Hernias Image 1: Types of Volvulus from diaphragmatic hernias Image 2: Can you name this type of ulcer? https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb388d9c038272a6f08691a/1588824308238/hh3.PNG Para-esophageal and Diaphragmatic Hernias COMPLICATIONS Esophageal Perforation Splenic Injury Vagus Nerve Injury Recurrence https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eb38903d47d29453679155f/1588824335974/hh4.PNG Para-esophageal and Diaphragmatic Hernias https://www.residentreview.org/general-2 daily 0.75 2021-10-07 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ec070dcddb38d4ce0b06b4e/1589670147154/axilla+borders.png Axilla *from teachmeanatomy.com https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ec0724742d7f07cca65f400/1589670497332/SmartSelect_20200516-170609_Atlas.jpg Axilla https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e443109db5e1405f5c207/1633567818015/axilla+1.jpg Axilla Image from anatomynote.com https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ec077375ff2e369e5b9851f/1589672068160/Large+JPG-Aro+Ha_0380.jpg Axilla Stewart-Treves https://www.residentreview.org/sleeve-gastrectomy daily 0.75 2020-05-25 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb30575699191ae961f704/1590374492529/sg6.PNG Sleeve Gastrectomy Image from google images *sleeve gastrectomy involves removal of approximately 80% of the stomach https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb308f5699191ae961ffd3/1590374548954/sg5.PNG Sleeve Gastrectomy https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb32ccbb99ad6e8671654b/1590375122562/sg8.PNG Sleeve Gastrectomy https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb30da063db750f282e59d/1590374626112/sg2.png Sleeve Gastrectomy The celiac trunk blood supply From medchrome.com https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb35906dad0e25faaf8f21/1590375833525/sg3.png Sleeve Gastrectomy Staple heights https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb35bfab61810adcf8b6c4/1590375923579/sg4.PNG Sleeve Gastrectomy Complications include: Bleed, leak, stricture https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb351ea81cd4417d909820/1590375720109/sg9.PNG Sleeve Gastrectomy https://www.residentreview.org/rouxeny-gastric-bypass daily 0.75 2020-05-25 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb3aa702f4af1d188c1d2e/1590377133082/Large+JPG-20140228_Trade+151_0046.jpg Roux-en-Y Gastric Bypass https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb3ac0d6d7ad4f6c340c5c/1590377166943/ry4.PNG Roux-en-Y Gastric Bypass https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb3c63e3d0ce7bf2f885e1/1590377578416/ry2.PNG Roux-en-Y Gastric Bypass https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb3ca0642dba7bdd1abfba/1590377640490/ry1.PNG Roux-en-Y Gastric Bypass https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb3d8d8e07a301b02d25c8/1590377875291/ry3.PNG Roux-en-Y Gastric Bypass https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecb3d125060ad27ee180019/1590377751976/sg3.png Roux-en-Y Gastric Bypass https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ecb36deb4f8de1f776cbbea/5ecb39c540423e17efca9361/1590376904623/ry.PNG Roux-en-Y Gastric Bypass https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ecb36deb4f8de1f776cbbea/5ecb39cfd02304239ed00726/1590376913295/ry2.PNG Roux-en-Y Gastric Bypass https://www.residentreview.org/general-2-1 daily 0.75 2021-10-07 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecbdbdcb6e5372e0e24bfb6/1590418439747/20200525_083818.jpg Abnormal Nipple Discharge https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecbe014e7d73d6dee3dff5b/1590419485953/br.PNG Abnormal Nipple Discharge - Ductogram and a breast ultrasound Tx: If concerning… Surgical Lesion not localized: complete subareolar duct excision Lesion Localized: lacrimal -> prolene suture-> angiocath ->methylene blue-> isolate and remove duct. ***make sure to remove ENTIRE duct https://www.residentreview.org/parathyroid-review daily 0.75 2020-05-26 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecc65fd6dad0e25fada1c4d/1590454430032/pharyngeal%2Bpouches.jpg Parathyroid - Anatomy From the 3rd and 4th pharyngeal pouches 3rd pouch is associated with inferior parathyroid and thymus Found anteromedially More likely to be ectopic tail of thymus (MC), intrathyroid, mediastinum 4th pouch is associated with superior parathyroid and thyroid complex Found posterolaterally Inferior thyroid artery supplies both superior and inferior parathyroids https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecc67b45060ad27ee414115/1590454264343/PTH+hormones.jpg Parathyroid - Hormones PTH Increases calcium via: Kidney reabsorption in DCT Increase osteoclast activity in bone Increase Vit D production in kidney (1-OH) increase calcium binding in intestine Also increase PO4- excretion Vit D Increases Ca++ AND PO4- via intestine absorption Calcitonin Decrease calcium (INHIBITS OSTEOCLASTS) Increase urinary Ca++ and PO4- excretion https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecc7eec72e6a72aac3dc10e/1590460150528/para2.PNG Parathyroid The above is from radiopedia.org https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ecc6d34ab61810adc23eac1/1590455655197/MEN.png Parathyroid https://www.residentreview.org/caprini daily 0.75 2020-05-27 https://www.residentreview.org/ransons daily 0.75 2020-05-27 https://www.residentreview.org/childpugh daily 0.75 2020-05-27 https://www.residentreview.org/lrinec daily 0.75 2020-05-27 https://www.residentreview.org/abdominal-compartment-syndrome daily 0.75 2020-06-15 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7cb1058f6f305657a9c10/5ee7cf984272d276b05a111f/1592250272971/ACS1.png Abdominal Compartment Syndrome https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7cb1058f6f305657a9c10/5ee7cfccfb967e67f0eb53bc/1592250324226/Abdominal+Compartment+Syndrome.PNG Abdominal Compartment Syndrome https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7cb1058f6f305657a9c10/5ee7cffb4855790a43411728/1592250365118/bladder+pressure.PNG Abdominal Compartment Syndrome https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7cb1058f6f305657a9c10/5ee7d0174272d276b05a2df3/1592250393037/ACS3.png Abdominal Compartment Syndrome https://www.residentreview.org/carotid-artery-stenosis daily 0.75 2020-06-16 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee8e592f0fd4409145f6dcd/1592321530865/cas5.PNG Carotid Artery Stenosis An alternative to patients with prior neck surgery, neck radiation, prohibitive surgical candidates is carotid artery stenting. According to the CREST trial, this is associated with similar rates of stroke, MI, and death https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee8e4081280c00b33f7f829/1592321089653/cas1.PNG Carotid Artery Stenosis ECST = European Surgical Carotid Trial NASCET = North American Symptomatic Carotid Artery Trial https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee8e3e0a1f77d250545f4e6/1592321015398/cas4.PNG Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee8e06459e1234117a232c2/1592320121024/cas3.PNG Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee8e03e0363d068a9c2f1eb/1592320077615/cas2.PNG Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee8e6098a2c4a1a2fb6ffea/5ee8e72d956cdf00600c4f12/1592321843651/cas6.PNG Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee8e6098a2c4a1a2fb6ffea/5ee8e72d97d2423426d1e746/1592321840837/cas7.PNG Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee8e6098a2c4a1a2fb6ffea/5ee8e7611f6811086e432cd8/1592321904339/20180129_141656.jpg Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee8e6098a2c4a1a2fb6ffea/5ee8e762a9206d257866f524/1592321901619/20180129_142254.jpg Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee8e6098a2c4a1a2fb6ffea/5ee8e76158f1c32d08615033/1592321903054/20180129_143421.jpg Carotid Artery Stenosis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee8e6098a2c4a1a2fb6ffea/5ee8e7631280c00b33f8b026/1592321900319/20180129_143929.jpg Carotid Artery Stenosis https://www.residentreview.org/pulmonary-embolism daily 0.75 2020-06-15 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee7ece1bb1a993deceb86bb/1592257865601/PE2.png Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee7ec6bf4ba336b550d2d70/1592257648021/PE1.png Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee7f6e99cbc990ded08e09c/1592260408622/pe7.PNG Pulmonary Embolism CTA showing a LEFT sided PE. VQ scan differentiating between normal and high probablity PE. High probabilty PE is defined as 2 or more segmental perfusion defects in the presence of normal ventilation https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee7f5719657c70648559a37/1592260023265/pe6.PNG Pulmonary Embolism Typically, Chest X Rays in PE patients will be NORMAL. They are used to exclude other pathologies If there are findings, look for vascular congestion, and infarcted lung https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5ee7f510be2c546850ff39e3/1592260216740/pe5.PNG Pulmonary Embolism The often tested S3 Q3 T3 is NOT the most common finding on EKGs RIGHT HEART STRAIN CAN BE SEEN WITH T WAVE INVERSIONS ON V1 to V4 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7ef85f4ba336b550db982/5ee7ef99db3b8842f57e95e2/1592258462992/PE3.PNG Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7f751bec47e0fd4e2116f/5ee7f7666626e80964311cb3/1592260464929/pe8.PNG Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7fc147f5d906d57c20ac0/5ee7fc28a9a2c05df154b75b/1592261678693/pe11.PNG Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7ef85f4ba336b550db982/5ee7ef996626e809642fbd29/1592258466215/PE4.PNG Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7f751bec47e0fd4e2116f/5ee7f7661dae3d310a31f451/1592260463999/pe9.PNG Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7fc147f5d906d57c20ac0/5ee7fc7c6385a77ecb099f81/1592261762019/pe12.PNG Pulmonary Embolism https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/5ee7f751bec47e0fd4e2116f/5ee7f766bb1a993deced72c1/1592260460306/pe10.PNG Pulmonary Embolism https://www.residentreview.org/chronic-limb-ischemia-part-1 daily 0.75 2020-06-19 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec409a6d9e375fed9a05e1/1592541793689/cle5.PNG Chronic Limb Ischemia part 1 (overview) Ankle-Brachial Index Take the higher of the brachial, and higher of of the ankle pressures https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec42ebaafa6d35eaf2b7b4/1592542137928/cle8.PNG Chronic Limb Ischemia part 1 (overview) look for multiphasic readings want toe pressures of >35 mmHg want amplitudes >30 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec442be29d0b7fa430907d/1592542282425/cle9.PNG Chronic Limb Ischemia part 1 (overview) https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec41bdecea7773b39f8dab/1592541640085/cle6.PNG Chronic Limb Ischemia part 1 (overview) https://www.residentreview.org/cli-pta-and-aortoiliac daily 0.75 2020-06-19 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec4e0ec5b95f50f2c48d2f/1592544820146/cle1.PNG Chronic Limb Ischemia part 2 (PTA) Aorto-iliac TASC A and B https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec4e417b14bd0e80cff5e6/1592544869461/cle3.PNG Chronic Limb Ischemia part 2 (PTA) Femoro-popliteal TASC A and B https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec4fab548491170f2a1a9c/1592545213214/cle10.PNG Chronic Limb Ischemia part 2 (PTA) from e-ultrasonography.org https://www.residentreview.org/general-4 daily 0.75 2020-06-19 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec55c980463449c932679b/1592546770678/cle2.PNG Chronic Limb Ischemia Part 3 (Surgical Management) https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec589e1a841c42a3017303/1592547501482/cle4.PNG Chronic Limb Ischemia Part 3 (Surgical Management) https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5eec5c421251976408612bce/1592548435287/cle12.PNG Chronic Limb Ischemia Part 3 (Surgical Management) https://www.residentreview.org/benign-esophageal-disease daily 0.75 2020-09-05 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5f52eaa200d4e20f38ae0c22/1599269586506/esophagus4.PNG Benign Esophageal Disease Schatzki’s Ring Almost all associated with sliding hiatal hernia Found at squamocolumnar junction Sx: dysphagia Dx: barium swallow Tx: dilation, PPI (not resection) https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5f52ebd336732345b4aed883/1599269851478/esophagus5.PNG Benign Esophageal Disease https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5f52e984a081cc5ab3fa2f9a/1599269293426/Esophagus3.PNG Benign Esophageal Disease https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5f52dbe17d267772ff36cf8b/1599265894602/esophagus1.PNG Benign Esophageal Disease Right vagus n. Posterior Cardiac plexus; Criminal nerve of Grassi: persistently high acid levels if undivided after vagotomy Left vagus n. Anterior Liver/biliary tree https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5f52ec937db55519621ce6ab/1599270041890/esophagus6.PNG Benign Esophageal Disease https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5f52e93200d4e20f38adef91/1599269173246/esophagus2.PNG Benign Esophageal Disease https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/5f52ecb300d4e20f38ae3de1/1599270072643/esophagus7.PNG Benign Esophageal Disease https://www.residentreview.org/aneurysms daily 0.75 2021-04-11 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/60737054ae641a2733535a37/1618179172165/aaa+chart.JPG Abdominal Aortic Aneurysm Urgent repair - Evidence of distal emboli - Known aneurysm that has become tender - Abdominal/back pain https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/607374302c90cb118bbae581/1618179156478/AAA+chart2.JPG Abdominal Aortic Aneurysm https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/607375a401a4c30c5bd99903/1618179623415/AAA+chart3.JPG Abdominal Aortic Aneurysm https://www.residentreview.org/general-2-2 daily 0.75 2021-10-05 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615b9ab4becab57a931f3733/1633393352343/cardiac+5.jfif Adult Cardiac image courtesy of brown.edu https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615ba0c3becab57a931fc419/1633394954864/cardiac+7.jpg Adult Cardiac Hirji et al. Study looking at 643 patients showed NO mid-long term survival difference between mechanical or bioprosthetic valves https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615ba1167557562b6a9fe726/1633395076904/Cardiac+6.png Adult Cardiac as presented by Dr. Mathew, Dr. Patel, and Dr. Low. July 2019. https://www.residentreview.org/breast-cancer-1 daily 0.75 2021-10-07 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e5894c39a0522840926cf/1633573021946/birads.JPG Breast Cancer 1 - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e5945ba954c3f15ab7cfa/1633573197176/20200525_083818.jpg Breast Cancer 1 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e608df5f02112c3ec0839/1633575228589/breast+contra.JPG Breast Cancer 1 Breast conserving therapy: defined as lumpectomy/segmentectomy w/ sentinel lymph node biopsy AND POST OPERATIVE RADIATION THERAPY (XRT) Goal is NO TUMOR ON INK ***Modified radical mastectomy is defined as taking all breast tissue, the nipple-areolar complex, level I nodes, and level II nodes https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e6014597b732d72e950f9/1633574958154/stages+of+breast+cancer.jpg Breast Cancer 1 From AJCC https://www.residentreview.org/breast-cancer-2 daily 0.75 2021-10-07 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e66358a02412d3b5a82c2/1633576528546/SLNB.jpg Breast Cancer 2 from cancer.gov https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e6789431cc4789ef0df4a/1633576927103/hormonal+therapy.JPG Breast Cancer 2 Tamoxifen and Anastrazole are for ER/PR + patients Give Tamoxifen to NON-menopausal women Give Anastrazole to POST-menopausal women Trastuzumab is for HER2/Neu positive patients https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e67f2e73e5a1940b1ef7b/1633577071197/breast+chemo.JPG Breast Cancer 2 Known side effects: Adriamycin (doxorubicin)- Cardiomyopathy Taxanes- Neuropathy Cyclophosphamide- hemorrhagic cystitis https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/615e68e509db5e1405f8206a/1633577354200/breast+cancer1.JPG Breast Cancer 2 Mammography and Ultrasound Study MLO = medial-lateral view (gives you vertical/up-down information) CC = cranio-caudal (gives you horizontal/side to side information) https://www.residentreview.org/intraabdominal-trauma-solid-organs-pt-1 daily 0.75 2021-10-17 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/616b8014aeefa1346b3d097c/1634435100779/spleen3.png Intra-abdominal Trauma: Solid Organs Pt 1 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/616b86347f47ea1b92eb4c1e/1634436674469/liver3.jpg Intra-abdominal Trauma: Solid Organs Pt 1 from clinmed international library https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/616b864ca8a6ea08fd8648f3/1634436707568/liver4.png Intra-abdominal Trauma: Solid Organs Pt 1 from AAST https://www.residentreview.org/general-1 daily 0.75 2021-11-02 https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/6180afad8dd7f307c90177cb/1635823595223/esoph1.gif Esophageal Perforation - Key Anatomic Regions: Cricopharngeus Broncho-aortic region Esophago-gastric region *Killian’s triangle- natural area of weakness over posterior esophageal muscularis. Cricophargeous and Oblique inferior constrictors https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/6180b03b07476234127bd82a/1635823948069/20210720_123208.jpg Esophageal Perforation Diagnosis: History/ Physical Exam- vomiting, trauma, ingestion, chest pain// crepitus Chest X-Ray - Pneumomediastinum, Subcutaneous Emphysema Esophogram - gastrograffin, dilute barium CT Chest https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/6180b24b1e351d4c7fca6b14/1635824216097/esoph2.JPG Esophageal Perforation https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/6180b35f6554a9014f0706f6/1635824554072/esoph3.jpg Esophageal Perforation From Operative Techniques in Thoracic and Cardiovascular Surgery (Dr. Raymond and Dr. Watson) https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/6180b5e4941cdd60a55bb58d/1635825226664/esoph4.jpg Esophageal Perforation Right sided approach if high thoracic (T6/7 and above) - via 6th or 7th rib posterolateral thoracotomy Left sided approach if low thoracic (T8 and below) - via 7th or 8th posterolateral thoracotomy Open up muscularis to reveal entire extent of perforation Two layer repair (inner absorbable, outer non absorbable) +/- flap Prepare pedicle flap early Evacuate Pleural Space Isolate perforation using a penrose drain Place chest tubes ***bail out- cervical diversion, irrigation, drainage, return when patient more stable https://static1.squarespace.com/static/5ea34e397d2b3c1912e3125f/t/6180b8bba1ccc41698d65350/1635825851344/esoph5.jfif Esophageal Perforation - Stenting: Extensive comorbidities Advance mediastinal sepsis Large defects Inability to tolerate more extensive surgery ***higher risk of failure if: cervical, GE junction, perf >6cm, persistent leak ***want to remove stents ideally <4weeks ***stents should be placed by experienced clinicians/ decision to do so by multidisciplinary team Endoluminal Sponges also now coming into play Post-Op: ICU ABX Nutrition consideration Consider Esophogram (5-7 days later)