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Trauma Surgery

downloadTrauma surgery is the branch of surgical medicine that deals with treating injuries caused by an impact. for example, a trauma surgeon may be called to the emergency room to evaluate a patient who is a victim of a car crash.

Trauma Explained

Trauma is the injuries suffered when a person experiences a blunt force. You may also hear trauma referred to as a “major trauma.” Many trauma patients are the victims of car crashes, stabbings, and gunshot wounds. Trauma can also be caused by falls, crush type injuries, and pedestrians being struck by a car.

Traumatic injuries can affect internal organs, bones, the brain, and the other soft tissues of the body. No area of the body is immune to trauma, but trauma can range from minor (hitting your finger with a hammer) to major (being hit by a car traveling at a high rate of speed or falling off of a building).

Who Performs Trauma Surgery

In the case of severe trauma, such as a catastrophic car crash, the trauma surgeon may be one part of a surgical team that includes general surgeons (to repair internal abdominal injuries), vascular surgeons (to repair damage to blood vessels), orthopedic surgeons (to repair broken bones), and other surgeons as needed.

The trauma team will include not only one or more surgeons, but also the paramedics who stabilize and transport the patient, nurses, anesthetist, respiratory therapist, radiographer, and the support of the medical laboratory scientists, including the blood bank.

For surgeons, extensive education is required in order to practice in their chosen field. As with all physicians, they first graduate from college with a bachelor’s degree and enter medical school for four years. For general surgeons, five years of surgical training as a residency is required. For surgeons who want to specialize, the same five-year residency is completed, followed by additional years of training in the area of specialization. Trauma surgery fellowships are usually one to two years long. Trauma surgeons often also serve a critical care fellowship. They take their boards for a certification in Surgical Critical Care.

From the Emergency Room to Surgery

A trauma surgeon has a different set of skills and functions from an emergency room doctor. When you arrive in the emergency room for any complaint, the ER doctor will see you, stabilize your condition, examine you, and order tests and imaging studies. She will alert the specialists needed, which may include the trauma surgeon. The ER doctor’s function includes referring you for admission or discharging you with appropriate treatment and follow-up referrals.

If your condition requires trauma surgery, you will be handed off to the trauma surgeon, who will become your provider. She will not only perform the surgery but you will also be followed by her and her team through recovery, rehabilitation, and discharge. When you need emergency surgery, you may be treated at the facility where you arrived, or you may be transported to a facility that has the specialists needed for your condition. The trauma surgeon may not be available to examine you until you arrive at her facility.

The trauma surgeon is often the person responsible for prioritizing which of your injuries will be treated first and determining the order of the diagnostic and operative procedures needed.

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What is ERCP

What is ERCP?

Endoscopic Retrograde Cholangio Pancreatography (ERCP) is a method for getting into the bile duct and pancreas though the mouth. When invented over 40 years ago, ERCP was a breakthrough that allowed doctors to find local diseases. Today, most local diseases can be detected safely by non-invasive imaging tests such as Computed Tomography (CT), Magnetic Retrograde CholangioPancreatography (MRCP) scans and an endoscopic method of imaging called Endoscopic Ultrasound (EUS). ERCP is used mainly to treat diseases that have been detected by these means.ercp_medium

ERCP uses an endoscope, which is a long flexible narrow tube with a camera at the end. After the patient is sedated, the specialist passes the endoscope through the mouth and esophagus, to view the lining of the stomach and first part of the small intestine (the duodenum). The goal is to access the papilla of Vater, a small nipple in the duodenum. This papilla is the drainage hole for the bile and pancreatic duct, which bring digestive juices from the livergallbladder and pancreas. The doctor injects contrast dyes through the papilla into the ducts and takes X-rays to show lesions such as stones, strictures or blockages. Some of these can be treated right away with other instruments passed through the endoscope.

Hernia Basics

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Hernia Basic
A bulging of an organ or tissue through an abnormal opening.
Common
More than 200,000 US cases per year
Treatable by a medical professional
Usually self-diagnosable
Lab tests or imaging rarely required
Medium-term: resolves within months
Typically, a hernia involves the stomach or intestine.
Symptoms include a bulge, swelling, or pain. In some cases, there are no symptoms.
Treatment includes monitoring the condition. If needed, surgery can return tissue to its normal location and close the opening.
Ages affected
0-2 Common
3-5 Rare
6-13 Rare
14-18 Common
19-40 Common
41-60 Very common
60+ Very common
Genders affected
Males Very common
Females Common

Your Gallbladder

493ss_getty_rf_gallbladder_anatomy_illustrationYour gallbladder sits on the right side of your belly, below your liver. It’s a small organ, shaped like a pear, that holds a fluid called bile. This liquid, made in your liver, helps you digest fats and certain vitamins. When you eat, your body gets the signal to release it — through channels called ducts — into your small intestine.
The most common reason people have trouble with their gallbladder is gallstones. You get them when bile clumps together and forms solid masses. They can be as big as a golf ball, and you can have just one or several.

If a gallstone gets into a duct and keeps bile from flowing out, your gallbladder can get inflamed. That’s called cholecystitis, and it can lead to nausea, vomiting, and belly pain. Bacteria also can cause it. You can tell you’re having gallbladder trouble by where it hurts: the upper right part of your belly. It might get worse when you take deep breath, .and you may also feel an ache in your back or right shoulder blade.

If You Think You Have a Problem

Your doctor will examine you and might want to take a sample of your blood to look for signs your body is fighting an infection. You probably will have an imaging test, like an ultrasound. It uses sound waves to make detailed images of your gallbladder. Your doctor also might want an X-ray of your belly or other blood tests to see how well your liver is working. Your doctor may recommend surgery, called cholecystectomy, to take out your gallbladder. You’ll be fine without it — the bile your liver makes will flow straight into your intestine.

 

From Web MD

 

Hernia Basics

download
A bulging of an organ or tissue through an abnormal opening.
Common
More than 200,000 US cases per year
Treatable by a medical professional
Usually self-diagnosable
Lab tests or imaging rarely required
Medium-term: resolves within months
Typically, a hernia involves the stomach or intestine.
Symptoms include a bulge, swelling, or pain. In some cases, there are no symptoms.
Treatment includes monitoring the condition. If needed, surgery can return tissue to its normal location and close the opening.
Ages affected
0-2
Common
3-5
Rare
6-13
Rare
14-18
Common
19-40
Common
41-60
Very common
60+
Very common
Genders affected
Males
Very common
Females
Common

 

Gastrointenstinal Surgery

gastrointestinal-surgery-500x500

Upper gastrointestinal surgery, often referred to as upper GI surgery, refers to a practise of surgery that focuses on the upper parts of the gastrointestinal tract. There are many operations relevant to the upper gastrointestinal tract that are best done only by those who keep constant practise, owing to their complexity. Consequently, a general surgeon may specialise in ‘upper GI’ by attempting to maintain currency in those skills.

Upper GI surgeons would have an interest in, and may exclusively perform, the following operations:

Lower gastrointestinal surgery includes colorectal surgery as well as surgery of the small intestine.

Academically, it refers to a sub-specialisation of medical practise whereby a general surgeon focuses on the lower gastrointestinal tract.

In the U.S., a student wanting to specialize and practice in adult lower GI surgery would generally have to go through four years of undergraduate college pre-medical education and get a bachelor’s degree, then finish the four years of medical school, then finish a typically five-year-long residency in general surgery, and then perform a subsequent one-year-long (minimum) residency in surgery of the small intestine or large intestine (the colon– specifically, the cecum, the vermiform appendix, the ascending colon, the transverse colon, the hepatic flexure and the splenic flexure, the descending colon, and the sigmoid colon; and also the rectum and the anus). A fellowship (in surgery of the small intestine or of the large bowel, or in pediatric/neonatal lower GI surgery, or in surgery of congenital abnormalities or rare disorders of the lower GI tract, or in emergency/trauma surgery or in cancer surgery of the area), would add on approximately one to three more years.[1]

lower GI surgeon might specialise in the following operations:

  • Colectomy
  • Low or ultralow resections for rectal cancer, etc.

Worst Foods for Digestion

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FRIED FOODS:  They’re high in fat and can bring on diarrhea. Rich sauces, fatty cuts of meat, and buttery or creamy desserts can cause problems, too.

Choose roasted or baked foods and light sauces that feature vegetables instead of butter or cream.

CITRUS FRUITS: Because they’re high in fiber, they can give some folks an upset stomach. Go easy on oranges, grapefruit, and other citrus fruits if your belly doesn’t feel right.

ARTIFICIAL SWEETENER:  Chew too much sugar-free gum made with sorbitol and you might get cramps and diarrhea. Food made with this artificial sweetener can cause the same problems.

The FDA warns that you might get diarrhea if you eat 50 or more grams a day of sorbitol, though even much lower amounts reportedly cause trouble for some people.

TOO MUCH FIBER:  Foods high in this healthy carb, like whole grains and vegetables, are good for digestion. But if you start eating lots of them, your digestive system may have trouble adjusting. The result: gas and bloating. So step up the amount of fiber you eat gradually.

BEANS  They’re loaded with healthy protein and fiber, but they also have hard-to-digest sugars that cause gas and cramping. Your body doesn’t have enzymes that can break them down. Bacteria in your gut do the work instead, giving off gas in the process.

Try this tip to get rid of some of the troublesome sugars: Soak dried beans for at least 4 hours and pour off the water before cooking.

CABBAGE AND ITS COUSINS:  Cruciferous vegetables, like broccoli and cabbage, have the same sugars that make beans gassy. Their high fiber can also make them hard to digest. It will be easier on your stomach if you cook them instead of eating raw.

FRUCTOSE:  Foods sweetened with this — including sodas, candy, fruit juice, and pastries — are hard for some people to digest. That can lead to diarrhea, bloating, and cramps.

SPICY FOODS:  Some people get indigestion or heartburn after eating them, especially when it’s a large meal.

Studies suggest the hot ingredient in chili peppers, called capsaicin, may be a culprit.

DAIRY FOODS:  If they trigger diarrhea, bloating, and gas, you may be “lactose intolerant.” It means you don’t have an enzyme that digests a sugar in milk and other forms of dairy.

Avoid those foods or try an over-the-counter drop or pill that has the missing enzyme.

PEPPERMINT : It can relax the muscle at the top of the stomach, which lets food move back into your esophagus. That can cause heartburn. Other culprits include chocolate or coffee.

Experts say you can lower the pressure that pushes the food back up if you lose extra weight, eat smaller portions, and don’t lie down after eating.

Also, learn what foods give you problems, so you can avoid them.

 

From Medicine.Net

DSA Surgeon Matthew Johnson is a fellowship trained GI & Critical Care physician.

DSA Surgeon Matthew Johnsonblausen_0316_digestivesyste is a fellowship trained GI & Critical Care physician. Gastrointestinal diseases (GI) refer to diseases involving the gastrointestinal tract, namely the esophagus, stomach, small intestine, large intestine and rectum, and the accessory organs of digestion, the liver, gallbladder, and pancreas.

New robotic surgery system arriving in 2019

1300-hospital-robot-future-timeline-technologyA next-generation surgical robotic system has been developed in Cambridge, UK. It will be used on NHS patients for the first time in 2019.

The Versius robot seen here was designed and built by CMR Surgical, formed in 2014, whose five founders brought with them global experience across the diverse disciplines of surgery, medical device development, start-ups and commercialisation. In June 2018, the company announced a record-breaking financing round that raised $100m in total, Europe’s largest private Series B medical device funding raise.
CMR’s stated aim is “to make minimal access surgery available to all”, by creating “a paradigm shift in robotic-assisted surgery”. Minimal access surgery (sometimes known as keyhole or minimally invasive surgery) is an alternative to open surgery that was first pioneered around 40 years ago. For patients and healthcare providers alike, the benefits are numerous and compelling – reduced trauma, faster recovery and improved clinical outcomes. For example, the risk of infection from a robotically assisted hysterectomy is reduced by almost a factor of three compared with open surgery (from 6.5% to 2.2%).
There are an estimated six million open surgery procedures each year that could be performed using minimal access surgery. CMR Surgical believes that robotics opens up the potential for millions more people to benefit from laparoscopic surgery.
The Versius machine is a rival to the American da Vinci system. CMR expects to introduce their new robotic system to hospitals within the next six months, beginning in the UK and Europe, then with international expansion shortly afterwards. The $4bn global market for surgical robots is predicted to increase five-fold to reach $20bn by 2024.

“Surgeons will remain in control, but as we develop the human-robot interface there may be simple parts of an operation, such as suturing or closing a wound that may be automated,” said Dr Hachach-Haram, a member of the Royal College of Surgeons’ Commission on the Future of Surgery.

GI Surgeries

gi tract2Gastrointestinal surgery is a treatment for diseases of the parts of the body involved in digestion. This includes the esophagus (ee-sof-uh-gus), stomach, small intestine, large intestine, and rectum. It also includes the liver, gallbladder, and pancreas.

Surgery may be used to remove a cancerous or noncancerous growth or damaged part of the body, such as the intestine. It may also be used to repair a problem like a hernia (a hole or weak spot in the wall of the abdomen). Minor surgical procedures are used to screen and diagnose problems of the digestive system.

Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope—a long, flexible, lighted tube. Many health problems can partly block a portion of your esophagus.