Indications of Manual Detorsion It can serve as a temporizing measure to attempt to reperfuse the testis while the patient is awaiting definite surgical management. Contraindications of Manual Detorsion Manual detorsion is not recommended for torsion of duration >6-8 hours (prolonged ischemia leads to marked swelling and edema after which…
Tag: General Surgery
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Wilm’s Tumor (Nephroblastoma) : Quick review
Wilm’s tumor is the most common primary renal tumor of childhood. Origin: Embryonic nephrogenic (mesodermal) cells Mechanism: Deletion of WT-1 gene on chromosome 11 Pathology: a. Macroscopic (Gross): large, solitary tan to grey color mass; pale on cut section with areas of hemorrhage; 10% are bilateral or multicentric; grossly difficult…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Mathes and Nahai Classification of Muscle Flap based on Vascular Anatomy
Type Dominant pedicle Minor pedicle Example I 1 – Tensor Fascia Lata (TFL) II 1 1 Gracilis III 2 – Gluteus maximus IV – Multiple Sartorius V 1 Multiple Lattisimus dorsi Mnemonic: Ten Graceful Glutes Sat on Latrines Type I: TFL Type II: Gracilis Type III: Gluteus maximus Type IV:…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Gastrinoma (Passaro’s) triangle
Boundaries of Gastrinoma Triangle It is an imaginary triangle formed by 3 points in upper abdomen: Apex: Cystic duct-CBD junction Inferior point: 2nd part duodenum-3rd part duodenum junction Left lateral point: Pancreatic neck-body junction This area is located to the right of Superior Mesenteric Artery (SMA) i.e. Proximal duodenum and…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Cholangiocarcinoma (Bile Duct Cancer) – Quick Review
This article is in response to the request made by a reader in the comment section. Today, we will try to simplify the biliary tree cancers. Classification of Cholangiocarcinoma Second-order bile ducts act as the separation point between intrahepatic and extrahepatic cholangiocarcinoma. A. Inhtrahepatic – 10 to 20% B. Extrahepatic…
Clinical Skills and Approaches 
Ascitic Paracentesis : Practical Essentials
Absolute contraindications to Ascitic Tapping (Paracentesis) While some authors have claimed ascitic paracentesis to be free from absolute contraindications, others have listed following as absolute contraindications: Clinically evident fibrinolysis Disseminated Intravascular Coagulation (DIC) Clinically apparent oozing from needle sticks Acute abdomen requiring surgery Relative contraindications to Blind Paracentesis Ultrasound guided…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Liver Segments Explained with Mnemonic
Couniaud divided liver into 8 functional segments, each of which is supplied by it’s own portal triad (composed of a portal vein, hepatic artery and a bile duct). Hepatic veins divide the liver in saggital plane: 1. Middle hepatic vein: Divides the liver into right and left functional lobe. 2….
PGMEE, MRCS, USMLE, MBBS, MD/MS 
TNM and Staging of Gastric Carcinoma Simplified
Unique features of stomach in relation to TNM cancer classification 1. Cancer penetrates the muscular propria and invades the ligaments (gastrohepatic and gastrocolic, i.e. lesser and greater omentum respectively) subserosally without breeching the serosa. Gastric cancer invasion of the lesser and greater omentum is T3, not T4. Perforation of the…