Breast Modified

after
Radical
Mastectomy

3rd-6th Intercostal & anterolat.

: >
-
lat ·

ant. supraclavicular ER/PR () bleedin ER/PR/HER (+ )

>
-
upper pt .

endomet

intercostobrachial ① adjuvant
ca
menopause
:
AMOXIFEN ne

if cut
no
>
-
> loss : a201
Chemotherapy
-

aromatase -
post-menopause
:

sensation sa arm Inhibitor ↑ Osteoporous

rad thx
adjurant
DX

-C:dfor middletrast
~
larger 10 tumors

↳ screening

tissue
O HER
↓
(A) +
-
ER +, HER O

~ tamoxifi
anti-HER

↳ diagnostic .ML Julate ↳ trazutuema

↓ spot compression :

④ > int
mammary &
-
.

post. intercostal
axillary &
BIRADS
④ - int. thoracic FNAB F i clinical

radiograph
post. interostat O
axillary ⑦ ↓
I excision biopsy
Batron's plexus
2

3
a
specificmammographicfeatures Breast
*

A
4
t

B
~ asymmetric trickening 2
~ clustered microcos freefor

5
-

annual MRI rece Le

~ 20-25 % based on
fam hx

~
BRCA 1 /2 17 mass,
* Stereotypic (t) calcifications
-

~ fam wh" * Lore

-
invasivenes

rad 18-20 y
therapy
.
o
~
.

FNAB cytology
-
#

Cowden
~
Lifraumens ,
Bannayan ,

wh
or
fam
 firm , movable , 2 excise !
PALP ABLE &
=

pain
es

I
fibro denomen

menopause
post-mammogram
x

malignant - NAS
Anesthes a

inducti on

maintenance

~
sevoflurane
recovery

-sugammadex
-
neostigmine
 fungal
-
bacterial
-

PMN neutrophil
goiters
:

for
* Anaplastic ~ not RAI
if
urgery
,

>
long standing
-

multinuc
giant ,
.

* Papillary
- slow growing ,

painless

G +Z >
-

for nonpalpable thyroid nodules

solid vs cystic nodules

lymphadenopathy

MRI >
-
large , fixed ,
subternal goiterso

* RAI post-op for pts I :

(t) distal metastases

tumors > 4cm

extrathymidal -
I ar di
magrecur !
 NOTE :

ipsilateral ext .
car ofid & vein
(t) malignant ;
↓ SUP
31 just
↓: no RAI

sup .
a
Thyroid M surgery !

/ -S
info-brachioph.
the
apex o * RAI -

for grave's

ant . post
RLN

⑫ O
L

avita
~ vague >
supracar ~
ragus

Lesso : O
u/

~ paramedian : No ,
weak

abducted : house , ineff ·

cough

. ⑭
ty
inf .
- runs RIN
~ lose o voice

abs.
airway
thyrcervical trunk
↑
subclavian
O
Perforated PUD
Stomach Bleeding PUD
Indications for surgery
Physiology of acid secretion - recurrent
~
bleedg
~ massive hemorrhage
response

~ early reho e more blood

"
"
simple patch closure

High risk
~ post. anode
~ 2CM

~ snock
nal Uker A
~ 4 units 8 blood in 24hrs
~ lesser curvature
- 8 Units"
"
"48h
0
.

i G .
Q
Surgical options for ulcer
↳ NON-SURGICAL If
1

-
() signs8 peritonitis
sealed perforation

d
 Gastric tumors
Benignn
T I 1 a min
* Leiomyomas
2 musculars propria -benign smooth ms
. Tumor
,

3 subserosal CT J visceral peritoneum &

submucosal &
-
firm
strux
adj .

4 TY
a
< 2cm observe
visceral peritoneum
2 cm
>
wedge resection
b adj . strux

* Lipoma
N O none ~ submucosal , fatty
I 1 -

2
~ excum unlest
sympx
23 -

6
*
Gastroparous
3 > 7 10
relevant
~ most
surgically
a 7 15 do : gastric motility
-

b = 16 * Massive Upper GIB

acute GLB lig :

-
to
prox
·

treitz
M O

I Isolated Gastric Vances

8 O I fund's
Gastric Ca E-distal to fundus
>
-
↑
① Upper GI endoscopy a
biopsy 2)
esophageal
Abd C &N &
staging portal N
:
(t)
.

Oral country , Splenic v.

facimbens

Malignant
* Gastric Lymphoma
* Gastric newendung
Em/c @ Stomach (95 %)

↓
rare
-

~
non-Hodgkin
-

from ECL

If LOW GRADE
I-m/c ; gastinema to
pernicious arena

① TX/Eradicate .

Pylori
II -
MENI/2ES
& I >
-

radiath (XRT) III-sporadic

#I
"
>
-
& Chemo

III/IV >
-

Chemo * Adenocarcinoma

* GIST Gradical
subtotal
gastrectory
gastroepiploic &
~
↳
gastric &
from 152C
~ distal 2/3 stomach + pylomus
Imatinib ~ 2 cm duodenum

/ ~ all lymph
Stable progressio ~ greater & lesser omentum
/-

resea uni"
- multi
& if
-
stage I & III
un ↓
-

- ↓
~ radiothx
⑤ add chemo &

⑤ ① ⑪
aspirin ,
di et (front a
* Adenocarcinoma * Leiomyomas
Gradical
gastrectory subtotal -benign ,
smooth ms
. Tumor

-submucosal &
firm
~
gastric & gastroepiploic &
~ distal 2/3 stomach + pyloms TY
~ 2 cm duodenum S < 2 Cm observe

~ all lymph > 2 cm Wedge resection

~ greater & lesser omentum
POST-GASTRECTOMY PROBS
& if stage I & III

radiothx ① Dumping
~ add chemo &
-
destruxn o
pyloric sphincter
so
early dump's food a ↓d gastic
compliance
* Gastric
Lymphoma Early : 15-30 mins

↳ m/c @ Stomach (95 %) & higda & Saline

↓
2 3n
non-Hodgkin Late : -

~
hypogly
& sugar

If LOW GRADE main tx : diet modif

ocreotide somatostatin

① TX/Eradicate .

Pylori analogue)

& I >
-

radiath (XRT) ② Diarrhea

-
20 TV , dumpg , malabriptor
#I
"
>
-
& Chemo

③ Gastric Stasis
III/IV >
-
Chemo
④ Bile Reflux Gastritis &

Endoscopic resection ty
*
Esophagitis
Go early Gastria ca
⑤ Roux syndrome
< 2 cm
⑥ Gallstones
& mucosa

well-defined ! ⑦ Wt .
10
malabsorpee ans
Int a re

& Anemia

⑨ Bone se
 10 survey
Findings on chest radiograph suggestive

ery
-definitive
sur
care of a descending thoracic aortic tear

Tertiary survey

patent airway
>
- cervical spine immob .

deviated trached

-
MAL
affected side
> 8 thoracotomy in > CXR
↓ 'd breath sounds
-

on

G field :
emphysema

>
-

↳OmmHy-I carotid

BOOMI
(7 femoral
70
-

>
-(radial
INTHBATION
23%
dated neck
altered consciousness -m/c
Beak's
triad muffled &S
↓ AP
cause

-
thoracic wounds orotracheal intubation -
-Post-penetrating
-

Algorithm: use of resuscitative thoracotomy

SHOCK

fluid resuscitation / ISOTONIC CRYSTALLOID

lactate
↳ ringer's

D but if persistent hypo = RBC & FFP

Tension
preumo-blunt-thoracostry
& tamp
 Algorithm for the initial evaluation of a patient with suspected blunt abdominal trauma

Algorithm for the management of penetrating neck injuries

&

Algorithm: use of resuscitative thoracotomy

Algorithm for the evaluation of penetrating abdominal injuries.

Phenmothorax
-

browhorl
# BLUNT >
-

X-ray e
*
Ult

lead
Formaten en
Anders
↓
co
zens!
Gusti se

&
ma
27t
:
cardeinprnee
actions
HEPATOBILIARY SYSTEM

LEPHYSO

T
I liver meal
from
↳ cholesterol (C) metals ↳enter endocrine
cells -

↳ form
10 bile salts
Xcholateexychulate duodenum
Y
mixes prox jeju
.

Cr GB contraxn
taurine
S
-
&

relaxatio

(
-glycine Soo

excreted by hepatocytes
All
= GB empty g
help
:
digestion
enterdep
> Cuf: iverede
60-90m = GB
fat absorption
+
! refills 22

ranitesee
,
Ch
arch

↳ conjugated
!

↓
↓ where artico apply
↳
20 bile acids
~ deoxycholate
~ lithocolate

↳ absorbed into colon * best non-invasive : MRCP

↓ * 1C
pt :
percutaneous chol.
back to liver !
* symptomatic gallstones :
intraop .

cholangiogram
Contraxn
choledocho/cholangitis/obs jaundice
:
* inhibit
GB * ·
:
ERCP
- somatostatin
* ↑ bilimbin
,
dilated hepatic ducts , No CBD :
PTC w/drainage
~ VIP

↑
:
GB

- CCK