Surgery Flashcards
(14 cards)
What is Testicular Torsion?
- Surgical emergency
- Twisting of spermatic cord resulting in constriction of vascular supply and ischaemia of testicular tissue
- Intravaginal : twisting within tunica vaginalis (most common cause of acute scrotal pain in 10-18yo)
Extravaginal : entire testis and tunica vaginalis twists (happens in neonates)
RF for Testicular Torsion
- Age under 25
- Bell clapper deformity
- allows testicles to rotate freely within tunica vaginalis
- accounts for most cases of intravaginal torsion
H&E for Testicular Torsion
- Pain
- Swelling
- Unilateral
- High-riding testicle
- Absent cremasteric reflex
- Negative Prehn’s sign (elevation of affected testis does not relieve pain)
Investigations for Testicular Torsion
Doppler USS will show whirlpool sign
Management of Testicular Torsion
WITHIN 6 HOURS OF SYMPTOM ONSET, DO NOT DELAY FOR DOPPLER USS
- Emergency exploration of scrotum + bilateral orchidopexy
Manual de-torsion if surgery not available in 6 hours
What is a Fibroadenoma?
Formed from glandular and stromal tissue
Develop from a whole lobule
H&E of Fibroadenoma
- <30 years old
- Mobile, firm, smooth, rubbery lump (breast mouse)
- Non tender
Investigations for Fibroadenoma
- USS + re-scan in 3-6 months to monitor growth
- Biopsy if >25/very large
Management of Fibroadenoma
- <4cm : conservative management - should shrink over 2 years
- > 4cm, rapidly enlarging or symptomatic : excision
What is a Extradural/ Epidural haematoma?
Collection of blood between skull and dura
Almost always caused by trauma - most typically ‘low-impact’
MC place for Extradural haematoma to occur
Temporal region since skull at pterion overlies MIDDLE MENINGEAL ARTERY and is vulnerable to injury
H&E of Extradural Haemorrhage
- Patient loses consciousness, gains it and then loses it again due to raising ICP + brain herniation - lucid interval
- Raised ICP
- Fixed and dilated pupil = compression of parasympathetic fibers of third CN
Investigations for Extradural Haemorrhage
- CT head = biconvex (lentiform), hyper dense collection, limited by suture lines of the skull
Management of Extradural Haemorrhage
Definitive is Craniotomy and evacuation of haematoma
- Life threatening ICP = IV mannitol/furosemide may be needed
- ICP monitoring for GCS 3-8
- Hyponatraemia due to SIADH
- Minimum cerebral perfusion pressure 70mmHg in adults and 40-70mmHg in kids
