Surgery Signs,Triads n Syndromes

7/25/2019 Surgery Signs,Triads n Syndromes

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Rubor

Steatorrhea

Stenosis

Sterile field

Succus

Tenesmus

Thoracotomy

Transect

Trendelenburg

Urgency

Wet-to-dry dressing

Redness; a classic sign of inflammation

Fatty stools as a result of decreased fat

absorption

Abnormal narrowing of a passage oropening

Area covered by sterile drapes or preppedin sterile fashion using antiseptics (e.g.,Betadine®)

Fluid (e.g., succus entericus is fluid fromthe bowel lumen)

Urge to defecate with ineffectualstraining

Surgical opening of the chest cavity

To divide transversely (to cut in half)

Patient posture with pelvis higher thanthe head, inclined about 45 (a.k.a.“headdownenburg”)

Sudden strong urge to urinate; often seen with a UTI

Damp gauze dressing placed on a wound and removed after the dressingdries to the wound, providingmicrodébridement

Chapter 1 / Introduction 25

What are the ABCDs of melanoma?

Signs of melanoma: A symmetricBorder irregularitiesColor variationDiameter 0.6 cm and Dark color

SURGERY SIGNS,TRIADS, ETC. YOU SHOULD KNOW

Surgery Signs, Triads and

Sydromes

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26 Section I / Overview and Background Surgical Information

Ulnarartery

Radialartery

Define the following terms:Ballance’s sign

Barrett’s esophagus

Battle’s sign

Constant dullness to percussion in theleft flank/LUQ and resonance topercussion in the right flank seen withsplenic rupture/hematoma

Columnar metaplasia of the distal

esophagus (GERD related)

Ecchymosis over the mastoid process inpatients with basilar skull fractures

Battle’ssign

What is the Allen’s test? Test for patency of ulnar artery prior toplacing a radial arterial line or perform-ing an ABG: Examiner occludes both

ulnar and radial arteries with fingersas patient makes fist; patient opensfist while examiner releases ulnarartery occlusion to assess blood flow to hand




Beck’s triad

Bergman’s triad

Blumer’s shelf

Boas’ sign

Borchardt’s triad

Carcinoid triad

Charcot’s triad

Chvostek’s sign

Courvoisier’s law

Seen in patients with cardiac tamponade:1. JVD2. Decreased or muffled heart sounds

3. Decreased blood pressure

Seen with fat emboli syndrome:1. Mental status changes2. Petechiae (often in the axilla/thorax)3. Dyspnea

Metastatic disease to the rectouterine(pouch of Douglas) or rectovesical pouchcreating a “shelf” that is palpable onrectal examination

Right subscapular pain resulting fromcholelithiasis

Seen with gastric volvulus:1. Emesis followed by retching

2. Epigastric distention3. Failure to pass an NGT

Seen with carcinoid syndrome (Think:“FDR”):

1. Flushing2. Diarrhea3. Right-sided heart failure

Seen with cholangitis:1. Fever (chills)2. Jaundice3. Right upper quadrant pain

(Pronounced “char-cohs”)

Twitching of facial muscles upon tapping the

facial nerve in patients with hypocalcemia(Think: CH vostek’s CHeek)

Enlarged nontender gallbladder seen withobstruction of the common bile duct,most commonly with pancreatic cancer Note: not seen with gallstone obstructionbecause the gallbladder is scarred

secondary to chronic cholelithiasis(Pronounced “koor-vwah-ze-ay”)



Cullen’s sign


Bluish discoloration of the periumbilicalarea due to retroperitoneal hemorrhagetracking around to the anterior abdominal

wall through fascial planes (e.g., acutehemorrhagic pancreatitis)

Umbilicus

Cushing’s triad

Dance’s sign

Fothergill’s sign

Fox’s sign

Goodsall’s rule

Signs of increased intracranial pressure:1. Hypertension2. Bradycardia3. Irregular respirations

Empty right lower quadrant in children with ileocecal intussusception

Used to differentiate an intra-abdominalmass from one in the abdominal wall; if mass is felt while there is tension on themusculature, then it is in the wall (i.e.,sitting halfway upright)

Ecchymosis of inguinal ligament seen

with retroperitoneal bleeding

Anal fistulae course in a straight pathanteriorly and a curved path posteriorly from midline (Think of a dog with astraight anterior nose and a curvedposterior tail)



Grey Turner’s sign

Hamman’s sign/crunch

Homans’ sign

Howship-Romberg sign

Kehr’s sign

Kelly’s sign

Krukenberg tumor

Laplace’s law

Ecchymosis or discoloration of the flankin patients with retroperitonealhemorrhage as a result of dissectingblood from the retroperitoneum (Think:TURNer’s TURN side-to-side flank)

Crunching sound on auscultation of theheart resulting from emphysematousmediastinum; seen with Boerhaave’s

syndrome, pneumomediastinum, etc.

Calf pain on forced dorsiflexion of thefoot in patients with DVT

Pain along the inner aspect of the thigh;seen with an obturator hernia as theresult of nerve compression

Severe left shoulder pain in patients with splenic rupture (as a result of referred pain from diaphragmaticirritation)

Visible peristalsis of the ureter inresponse to squeezing or retraction;

used to identify the ureter duringsurgery

Metastatic tumor to the ovary (classically from gastric cancer)

Wall tension pressure radius (thus,the colon perforates preferentially at the

cecum because of the increased radiusand resultant increased wall tension)


Anterior

Goodsall

Posterior



McBurney’s point

McBurney’s sign

Meckel’s diverticulumrule of 2s

Mittelschmerz

Murphy’s sign

Obturator sign


One third the distance from the anterioriliac spine to the umbilicus on a lineconnecting the two

Tenderness at McBurney’s point inpatients with appendicitis

2% of the population have a Meckel’sdiverticulum, 2% of those are symptomatic,and they occur within 2 feet of theileocecal valve

Lower quadrant pain due to ovulation

Cessation of inspiration while palpatingunder the right costal margin; thepatient cannot continue to inspiredeeply because it brings an inflamedgallbladder under pressure (seen inacute cholecystitis)

Pain upon internal rotation of the leg with the hip and knee flexed; seen inpatients with appendicitis/pelvic abscess

PheochromocytomaSYMPTOMS triad

Pheochromocytoma ruleof 10s

Think of the first three letters in the word pheochromocytoma—“P-H-E”:

PalpitationsHeadacheEpisodic diaphoresis

10% bilateral, 10% malignant, 10% inchildren, 10% extra-adrenal, 10% have

multiple tumors



Raccoon eyes Bilateral black eyes as a result of basilarskull fracture

Reynold’s pentad

Rovsing’s sign

Saint’s triad

Silk glove sign

1. Fever2. Jaundice3. Right upper quadrant pain

4. Mental status changes5. Shock/sepsisThus, Charcot’s triad plus #4 and #5; seen

in patients with suppurative cholangitis

Palpation of the left lower quadrantresulting in pain in the right lowerquadrant; seen in appendicitis

1. Cholelithiasis2. Hiatal hernia3. Diverticular disease

Indirect hernia sac in the pediatricpatient; the sac feels like a finger of a silkglove when rolled under the examining

finger


Psoas sign Pain elicited by extending the hip withthe knee in full extension, seen withappendicitis and psoas inflammation



Sister Mary Joseph’s sign(a.k.a. Sister Mary Joseph’s node)

Virchow’s node

Virchow’s triad

Trousseau’s sign

Valentino’s sign

Westermark’s sign

Whipple’s triad


Metastatic tumor to umbilical lymphnode(s)

Metastatic tumor to left supraclavicularnode (classically due to gastric cancer)

Risk factors for thrombosis:1. Stasis2. Abnormal endothelium3. Hypercoagulability

Carpal spasm after occlusion of blood tothe forearm with a BP cuff in patients with hypocalcemia

Right lower quadrant pain from aperforated peptic ulcer due to succus/ pus draining into the RLQ

Decreased pulmonary vascular markings onCXR in a patient with pulmonary embolus

Evidence for insulinoma:1. Hypoglycemia (50)2. CNS and vasomotor symptoms

(e.g., syncope, diaphoresis)3. Relief of symptoms with

administration of glucose

What is afferent loopsyndrome?

What does ARDS stand for?

Surgical

Syndromes

Chapter 2

Obstruction of the afferent loop of aBillroth II gastrojejunostomy

A cute Respiratory Distress S yndrome(poor oxygenation caused by leakycapillaries)

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What is blind loop syndrome?

What is Boerhaave’ssyndrome?

What is Budd-Chiarisyndrome?

What is carcinoid syndrome?

What is compartmentsyndrome?

What is Cushing’s syndrome?

What is dumping syndrome?

What is Fitz-Hugh-Curtissyndrome?

What is Gardner’ssyndrome?

What is HITT syndrome?

Bacterial overgrowth of intestine causedby stasis

Esophageal perforation

Thrombosis of hepatic veins

Syndrome of “B FDR”:Bronchospasm

FlushingDiarrheaRight-sided heart failure (caused by

factors released by carcinoidtumor)

Compartmental hypertension caused by edema, resulting in muscle necrosis of

the lower extremity, often seen in thecalf; patient may have a distal pulse

Excessive cortisol production

Delivery of a large amount of hyperosmolar chyme into the smallbowel, usually after vagotomy and a

gastric drainage procedure (pyloroplasty/ gastrojejunostomy); results in autonomicinstability, abdominal pain, and diarrhea

Perihepatic gonorrhea infection

GI polyps and associated findings of Sebaceous cysts, Osteomas, and Desmoidtumors (SOD); polyps have high malig-nancy potential (Think: A Gardner plants SOD)

Heparin-Induced ThrombocytopenicThrombosis syndrome: Heparin-inducedplatelet antibodies cause platelets tothrombose vessels, often resulting in loss

of limb or life

Chapter 2 / Surgical Syndromes 33



What is Leriche’s syndrome?

What is Mallory-Weisssyndrome?

What is Mendelson’ssyndrome?

What is Mirizzi’s syndrome?

What is Munchausensyndrome?

What is Ogilvie’s syndrome?

What is Peutz-Jegherssyndrome?

What is Plummer-Vinsonsyndrome?

What is RED reactionsyndrome?

What is refeeding

syndrome?

What is Rendu-Osler-Weber (ROW) syndrome?

What is short-gut syndrome?


Claudication of buttocks and thighs,Impotence, A trophy of legs (seen withiliac occlusive disease) (Think: CIA )

Post-emesis/-retching tears in the gastricmucosa (near gastroesophageal junction)

Chemical pneumonitis after aspiration of gastric contents

Extrinsic obstruction of the commonhepatic bile duct from a gallstone in thegallbladder or cystic duct

Self-induced illness

Massive nonobstructive colonicdilatation

Benign GI polyps and buccal pigmenta-tion (Think: Peutz Pigmentation)

Syndrome of:1. Esophageal web2. Iron-deficiency anemia3. Dysphagia4. Spoon-shaped nails

5. Atrophic oral and tongue mucosaTypically occurs in elderly women; 10%

develop squamous cell carcinoma

Syndrome of rapid vancomycin infusion,resulting in skin erythema

Hypokalemia, hypomagnesemia, and

hypophosphatemia after refeeding astarved patient

Syndrome of GI tract telangiectasia/A-V malformations

Malnutrition resulting from 200 cm of viable small bowel



What is SIADH?

What is another name for Sipple’s syndrome?

What is superior vena cava(SVC) syndrome?

What is thoracic outletsyndrome?

What is Tietze’s syndrome?

What is toxic shocksyndrome?

What is Trousseau’ssyndrome?

What is another name for Wermer’s syndrome?

What is Zollinger-Ellison

syndrome?

Chapter 3 / Surgical Most Commons 35

S yndrome of Inappropriate A ntiDiureticHormone (Think: Inappropriately Increased ADH)

MEN II

Obstruction of the SVC (e.g., by tumor,thrombosis)

Compression of the structures exitingfrom the thoracic outlet

Costochondritis of rib cartilage; aseptic(treat with NSAIDs)

Staphylococcus aureus toxin-inducedsyndrome marked by fever, hypotension,organ failure, and rash (desquamation—especially palms and soles)

Syndrome of deep venous thrombosis(DVT) associated with carcinoma

MEN I

Gastrinoma and PUD

What is the most common:Indication for surgery with Crohn’s disease?

Type of melanoma?

Type of breast cancer?

Surgical MostCommons

Chapter 3

Small bowel obstruction (SBO)

Superficial spreading

Infiltrating ductal

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Surgery Signs,Triads n Syndromes

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