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:…
Tag: General Surgery
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…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
TNM and staging of Urinary Bladder Cancer Simplified
As discussed earlier in – TNM Classification and Cancer Staging Simplified, Urinary bladder is a hollow organ whose “T” classification resembles that of the gastrointestinal tract. Since, the regional lymph nodes of the urinary bladder also lie beyond the serosa like in colon and rectum, positive regional nodes are usually…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
TNM and Staging of Breast Cancer Simplified
TNM Classification for Breast Cancer Primary Tumor (T) T1: ≤2 cm (20 mm) mi: ≤1 mm a: 1-5 mm b: 5-10 mm c: 10-20 mm T2: 2-5 cm T3: >5 cm T4: Direct extension to chest wall and/or skin a: Chest wall (exclude only pectoralis muscle adherence/invasion) b: Ipsilateral ulceration, satellite nodules…