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03:50, 1 July 2025 SurgopaediaAdmin talk contribs created page Peritoneal cavity (Created page with " == Definitions: == * '''Mesentery:''' the collection of tissues that maintains abdominal digestive system organs in position and in continuity with other systems. * '''Peritoneum:''' a continuous serous membrane (single sheet of mesothelium - simple squamous epithelium of mesodermal origin) supported by a thin connective tissue stroma. It lines the innermost surface of the abdominal wall, from which it is reflected on to viscera where it is cont...") Tag: Visual edit
03:49, 1 July 2025 SurgopaediaAdmin talk contribs created page Anterior abdominal wall (Created page with "== '''Embryology''' == * The abdominal wall begins to develop in the early stages of embryonic differentiation into ectoderm, endoderm and mesoderm * Mesoderm splits into splanchnic and somatic layers, and the abdominal wall develops from the somatic layer * Initially this is a U-shaped structure in the embryonic abdominal wall, which allows free communication with the extra-embryonic coelom. It takes until the end of the third month for this...") Tag: Visual edit
03:48, 1 July 2025 SurgopaediaAdmin talk contribs created page Diaphragm (Created page with " Domed fibromuscular sheet that separates the thoracic and abdominal cavities. It's purpose is essentially for inspiration. == '''Embryology:''' == * '''Septum transversum''' is an involved structure which is formed from mesoderm, and acts as a framework for diaphragmatic development. Forms most of the central tendon. * '''Pleuroperitoneal membranes''' contribute by completely covering the septum transversum and therefore closing connection betw...") Tag: Visual edit
03:44, 1 July 2025 SurgopaediaAdmin talk contribs created page Oesophagus (Created page with " A 25cm muscular tube that connects the pharynx to the stomach == '''Embryology''' == * Cranial part of the gut tube, which starts forming around week four * Respiratory diverticulum (lung bud) forms at its ventral wall, and gradually partitions itself off ventrally by the trache-oesophageal septum * Rapidly lengthens with descent of the heart and lungs == '''Gross anatomy''' == === '''Relations:''' === ** '''Pleura''' *** On the right, full length...") Tag: Visual edit
03:43, 1 July 2025 SurgopaediaAdmin talk contribs created page Breast (Created page with " Breast or mammary gland * Modified apocrine sweat gland whose primary purpose is to produce milk * lies in the subcutaneous tissue of the anterior thoracic wall. == '''Embryology''' == * Begins to develop as early as the 5th week - 'milk lines' form along a line from the axilla to the inguinal region, of ectodermal origin ** Supernumerary nipples or even glands may form along this line * Distal aspect of milk lines begin to disappear by week...") Tag: Visual edit
03:42, 1 July 2025 SurgopaediaAdmin talk contribs created page Upper limb (Created page with "== '''Quadrangular space''' == * A gap in posterior wall of axilla where axillary nerve and posterior circumflex humeral artery exit into arm * Borders ** Subscapularis above ** Teres major below ** Long head of biceps medially ** Humerus laterally == '''Cubital fossa''' == * Triangular space which forms the transition between the arm and forearm * '''Boundaries''' ** Superior - imaginary line joining the medial and lateral humeral epicondyles ** Lat...") Tag: Visual edit
03:37, 1 July 2025 SurgopaediaAdmin talk contribs created page Axilla (Created page with "The pyramidal space between the upper arm and the side of the thorax, which permits the passage of the major neurovascular structures. == '''Anatomical boundaries:''' (pyramid shape - four walls, a base and an apex) == * '''Floor/base:''' axillary fascia, which extends between the four side-walls: 1) the anterior and posterior axillary folds; and 2) the serratus anterior and the deep fascia of the arm. ** The suspensory ligament from the lower border o...") Tag: Visual edit
03:33, 1 July 2025 SurgopaediaAdmin talk contribs created page Vascular system (Created page with "== '''Embryology''' == * Processes of blood vessel development ** Vasculogenesis in which vessels arise by coalescence of angioblasts *** Formation of major vessels ** Angiogenesis where vessels sprout from existing vessels *** Formation of the remainder of the system === '''Arterial system''' === ** '''Early vascular development''' *** Truncus arteriosus forms from the outflow tracts of both ventricles, and divides into the aorta...") Tag: Visual edit
03:28, 1 July 2025 SurgopaediaAdmin talk contribs created page Thoracic cavity (Created page with "The space between the ribs, sternum and vertebrae radially; the thoracic inlet superiorly; and diaphragm inferiorly. == '''Key relationships''' == * Tracheal bifurcation at T7 * '''Thoracic inlet''' ** Connects the root of the neck with the thorax ** Boundaries *** Posteriorly - T1 vertebral body and costovertebral joints *** Laterally - first ribs and costal cartilages *** Anteriorly - superior border of manubrium ** Contents *** Viscera ***...") Tag: Visual edit
03:25, 1 July 2025 SurgopaediaAdmin talk contribs created page Chest wall (Created page with " Made up of 12 thoracic vertebrae, 12 pairs of ribs and costal cartilages and the sternum, along with associated soft tissues. == '''Surface anatomy''' == * Jugular/supra-sternal notch * Angle of Louis ** Articulation of sternal angle and 2nd costal cartilage ** Defines upper third of thoracic cage ** Level of aortic arch and tracheal carina and T4-T5 * Nipple ** Men - 4th ICS, just lateral to the mid-clavicular line * Vertebra prominens - C7 sp...") Tag: Visual edit
03:06, 1 July 2025 SurgopaediaAdmin talk contribs created page Parathyroid (Created page with "== '''Embryology''' == * The two pairs of parathyroid glands develop from the 3rd and 4th pharyngeal pouches in about week five of gestation ** Superior parathyroid from dorsal 4th pouch *** Attaches itself to the dorsal surface of the caudally-migrating thyroid (which has partly formed from the ventral fourth pouch) *** More predictable anatomic location ** Inferior parathyroid from the 3rd pouch, along with thymus *** Inferior parathyroid from dorsal region *** Thymus...") Tag: Visual edit
03:05, 1 July 2025 SurgopaediaAdmin talk contribs created page Thyroid (Created page with "An endocrine gland in the neck. == '''Embryology''' == * Originates from two separate precursor tissues, which then fuse to form the thyroid === Median thyroid precursor ('anlage') === *** Forms from the primitive pharynx at G2 *** Appears as an epithelial proliferation in the floor of the pharynx between the tuberculum impar and copula, arising at the level of the second pharyngeal arch, between the first and second pharyngeal pouch *** Descends towards the primitiv...") Tag: Visual edit
03:02, 1 July 2025 SurgopaediaAdmin talk contribs created page Neck (Created page with "== '''Skin''' == * Relaxed skin tension lines generally have a gentle slope posterior to anterior == '''Fascia''' == * Many of the so-called fascial layers in the neck are over-defined and don't amount to much more than a slight thickening of connective tissue, which does not have much surgical importance === '''Superficial fascia''' === === '''Deep cervical fascia''' === ** '''Superficial (investing) layer''' - comparable to deep...") Tag: Visual edit
02:59, 1 July 2025 SurgopaediaAdmin talk contribs created page Parotid (Created page with "== '''Function''' == * Predominantly a serous salivary gland * Secretes saliva via the parotid duct into the oral cavity to facilitate mastication and swallowing == '''Embryology''' == * From ectoderm * Forms as a groove in the cheek, with ectodermal cells in the blind end of that groove/tunnel forming the gland == '''Gross anatomy''' == * Average weight 25g * Three surfaces - lateral, anterior and deep * Roughly triangular when viewed from l...") Tag: Visual edit
02:58, 1 July 2025 SurgopaediaAdmin talk contribs created page Ear (Created page with "== External acoustic meatus == * Divisions ** Lateral third (cartilaginous) ** Inner two-thirds (bony) * Runs from outer ear to middle ear (pinna to tympanic membrane) which is about 4cm * The junction between cartilaginous and bony parts is about 10-12mm from the tragus and is lateral to the plane of emergence of the facial nerve * 'Tragal pointer': a small cartilaginous extension of the external portion of the acoustic canal, at the junction w...") Tag: Visual edit
02:56, 1 July 2025 SurgopaediaAdmin talk contribs created page Face (Created page with "The face is the part of the front of the head between ears and from the chin to the hairline. == '''Skin''' == * Senile facial wrinkles lie at right angles to the line of pull of the underlying muscles == '''Muscles''' == * Mostly supplied by CNVII (facial) * Specialised members of the panniculus carnosus, which are differentiated to form groups around the orifices, with a sphincter and opposing dilator to each * Muscles of the eyelids ** Orbicularis oculi - sphinct...") Tag: Visual edit
02:55, 1 July 2025 SurgopaediaAdmin talk contribs created page Category:Anatomy (Created page with "Anatomy, embryology, physiology") Tag: Visual edit
02:54, 1 July 2025 SurgopaediaAdmin talk contribs created page Cranium (Created page with "== Layers of head == * Skin * Subcutaneous fat * Skull ** Outer table ** Diploe ** Inner table * Dura mater ** Fused to periosteum * Brain == Cranial nerves == For anatomical path, see 'nerves' under 'Neck' section {| class="wikitable" |No. |Name |Sensory/motor |Origin/target |Exit path |Function |Exam |- |I |Olfactory |Sensory | | |Smell from nasal cavity |Smell |- |II |Optic |Sensory |Retinal ganglion cells |Optic canal |Vision from retina to brain |VA, visual fields...") Tag: Visual edit
02:53, 1 July 2025 SurgopaediaAdmin talk contribs created page Skin (Created page with "== '''Microscopic anatomy''' == === '''Epidermis''' === ** Keratinized stratified squamous epithelium ** Divided into strata, corresponding to progress of skin cells from metabolically active cells at the basement membrane, to dead cells at the skin surface ** Cytoplasm of keratinocytes contains vacuoles containing melanin (melanosomes), the density of which varies according to the pigmentation of the skin ** '''Cell types''' *** Keratinocytes...") Tag: Visual edit
02:51, 1 July 2025 SurgopaediaAdmin talk contribs created page Autonomic nervous system (Created page with " == '''Autonomic nervous system background''' == * Motor part controls innervation of cardiac and smooth muscle and glands * Pathway between spinal cord and target organ is always interrupted by synapses in a ganglion - there are thus preganglionic and postganglionic fibres * Preganglionic SNS fibres are in the lateral horn cells of T1-L2 segments of the spinal cord (the thoracolumbar part of the autonomic nervous system, or 'thoracolumbar outflo...") Tag: Visual edit
02:50, 1 July 2025 SurgopaediaAdmin talk contribs created page Embryology (Created page with "== First week: primordial germ cells and fertilization == * Development begins with fertilization - the union between sperm and oocyte, forming the zygote ** Sperm and oocyte are gametes - derived from primordial germ cells that are formed in the epiblast during the second week and end up in the gonads ** Gametes undergo gametogenesis, including meiosis, to reduce their number of chromosomes and prepare for fertilization ** Spermatogenesis - spermatogonia are transforme...") Tag: Visual edit
07:48, 30 June 2025 SurgopaediaAdmin talk contribs created page Category:Thoracics (Created page with "Thoracic surgery.") Tag: Visual edit
07:47, 30 June 2025 SurgopaediaAdmin talk contribs created page Category:Critical care (Created page with "Sepsis, shock, critically-unwell patients.") Tag: Visual edit
07:46, 30 June 2025 SurgopaediaAdmin talk contribs created page Category:Biliary (Created page with "x") Tag: Visual edit
07:40, 30 June 2025 SurgopaediaAdmin talk contribs created page Shock (Created page with "''Shock is acute circulatory failure, with inadequate tissue perfusion causing cellular hypoxia'' * ''Can't be defined using systemic parameters, as it is possible to have inadequate perfusion with normal blood pressure'' == Aetiology == === Hypovolaemia === ** Haemorrhage ** Fluid loss ** Dehydration === Cardiogenic === ** MI ** Heart failure ** Arrhythmia === Obstructive === ** PE ** Cardiac tamponade ** Pneumothorax === Distributive === ** Sepsis ** Neurogen...") Tag: Visual edit
07:38, 30 June 2025 SurgopaediaAdmin talk contribs created page Empyema (Created page with "''Infection of the pleural space'' == '''Risk factors''' == * Young or elderly * Intrinsic lung disease (COPD) * Diabetes or other immunosuppression * Alcohol * IVDU == '''Aetiology''' == === Primary (complication of lung infection) === ** Parapneumonic *** Parapneumonic effusions occur in patients with concurrent LRTI or pneumonia *** Normally an exudate *** Accompanies and often worsens the pneumonia === Secondary (extrinsic) === ** Trauma ** Thoracic surgery **...") Tag: Visual edit
06:10, 30 June 2025 SurgopaediaAdmin talk contribs created page Periampullary cancer (Created page with "== Four common types: == === '''Pancreatic ductal adenocarcinoma (~80%)''' === ** Also most aggressive of these - only 15% of patients are surgical candidates at diagnosis ** Among those who have surgery, median survival is 20 months, and 5 year survival of 20% ** Commonly 50-70yo ** RFs: *** Smoking *** Obesity *** T2DM *** Family history === '''Distal cholangiocarcinoma (~10%)''' === ** Distal CCA arises in CBD between junction of cystic duct and ampulla of Vater *...") Tag: Visual edit
06:09, 30 June 2025 SurgopaediaAdmin talk contribs created page Choledochal cyst (Created page with "== '''Rare congenital condition''' == * Usually develops in infancy/childhood * Often associated with Anomalous Pancreatobiliary duct junction (APBDJ) in 80-90% ** Defined as pancreatic duct joining CBD >15mm proximal to ampulla ** Results in long common channel ** Results in free reflux of pancreatic secretions into the biliary tract, increased biliary pressures, inflammatory changes in biliary epithelium ** This may be related to formation of choledochal cysts * Incid...") Tag: Visual edit
06:07, 30 June 2025 SurgopaediaAdmin talk contribs created page Cholangiocarcinoma (Created page with "== '''Epidemiology''' == * Common in south-east Asia (due to endemic liver flukes) * Generally 50-70yo at diagnosis, but younger if there is a clear predisposing factor such as PSC == '''Risk factors''' == * Anything that causes biliary inflammation, and compensatory cellular proliferation === Modifiable === ** Alcohol abuse ** Obesity (NASH/NAFLD) ** Diabetes ** Carcinogens *** Thorotrast *** COCP *** Asbestos *** Smoking === Non-modifiable === ** Sclerosing chol...") Tag: Visual edit
06:03, 30 June 2025 SurgopaediaAdmin talk contribs created page Primary biliary cholangitis (Created page with "Previously called 'primary biliary cirrhosis' == Aetiology == * Unknown, but probably an environmental trigger in a genetically-susceptible person * Environmental ** 25 per million in Australia; 250 per million in UK ** Infections possibly causing molecular mimicry - viruses, bacteria ** Chemical * Genetic ** Clustering within families == Pathophysiology == * T-lymphocyte-mediated attack on small intralobular bile duct epithelial cells * Leads to gradual destruction...") Tag: Visual edit
05:55, 30 June 2025 SurgopaediaAdmin talk contribs created page Primary sclerosing cholangitis (Created page with "Chronic inflammatory disease characterised by strictures of the intrahepatic and extrahepatic biliary tree * Generally progressive == Pathophysiology == * Poorly understood * Likely autoimmune * ?Bacterial translocation and infection * Genetic factors, although complex and polygenetic, exist == Aetiology == * 2/3 male * Average age 40s === Associated with: === ** UC (most common - 60-90% of cases) ** Crohns ** T1DM ** Thyroiditis ** Autoimmune hepatitis ** Ankylos...") Tag: Visual edit
05:44, 30 June 2025 SurgopaediaAdmin talk contribs created page Biliary strictures (Created page with "== Workup for cholestatic pattern, with suspected stricture == * USS * MRI (CT considered better by some for distal duct obstruction) * FBE, CA19-9, CEA, IgG, IgG4, HIV * If still no clear cause, probably going to need ERCP == Benign biliary strictures - end result of either traumatic injury or inflammatory processes. == === Iatrogenic injury (most common cause) === ** Usually cholecystectomy - see 'cholecystectomy' page for how to avoid, and classification (Stras...") Tag: Visual edit
05:42, 30 June 2025 SurgopaediaAdmin talk contribs created page Pneumobilia (Created page with " == Aetiology == === Recent biliary instrumentation === ** ERCP ** CBD stent placement ** PTC or IOC === Incompetent sphincter of Oddi === ** Sphincterotomy ** Following passage of a gallstone ** Scarring e.g. chronic pancreatitis ** Drugs e.g. atropine ** Congenital === Biliary-enteric surgical anastomosis === ** Cholecystoenterostomy ** Choledochoduodenostomy ** Whipple === Spontaneous biliary-enteric fistula === ** Cholecystoduodenal ** P...") Tag: Visual edit
05:41, 30 June 2025 SurgopaediaAdmin talk contribs created page Bilhaemia (Created page with "Extremely rare condition in which bile flows into the bloodstream through the hepatic veins or portal vein branches == Pathophysiology == * Caused by high intra-biliary pressure exceeding that of the venous system * Can be caused by gallstones eroding into the portal vein or accidental or iatrogenic trauma * Usually low-flow, and fistulas close spontaneously == Presentation == * Rapidly increasing jaundice * Marked direct hyper-bilirubinaemia without elevation of hep...") Tag: Visual edit
05:40, 30 June 2025 SurgopaediaAdmin talk contribs created page Haemobilia (Created page with "Bleeding into the biliary tree from an abnormal communication between a blood vessel and a bile duct == Aetiology == * Iatrogenic trauma to liver and biliary tree (most common - 50%) ** Percutaneous liver biopsy 1% ** PTC 2-10% ** Liver resections ** Cholecystectomy * Trauma * Gallbladder inflammation * Primary vascular diseases ** Aneurysms ** Angiodysplasia ** Haemangiomas * Malignancy * Parasitic infections * Hepatic abscesses * Cholangitis == Presentation == * Cl...") Tag: Visual edit
05:39, 30 June 2025 SurgopaediaAdmin talk contribs created page Obstructive jaundice (Created page with "== Aetiology (bold most common) == * Benign ** '''Choledocholithiasis''' ** Benign stricture (see separate topic) ** Inflammatory *** Chronic pancreatitis *** Pseudocyst *** PSC *** IgG4 cholangiopathy *** Post-radiation therapy ** Infectious *** TB *** Viral *** Parasitic *** HIV cholangiopathy ** Other *** Ischaemic (hepatic artery thrombosis) *** Trauma *** Vasculitis *** Mirizzi's syndrome *** Post-biliary sphincterotomy * Malignant ** '''Pancreatic''' ** Cholangioc...") Tag: Visual edit
05:38, 30 June 2025 SurgopaediaAdmin talk contribs created page Gallbladder cancer (Created page with "== '''Epidemiology''' == * Generally occurs 50-70yo * High incidence in: ** Bolivia ** Chile ** India ** Pakistan ** Poland * Rare in Western countries (1.13 per 100,000) ** F:M 2:1 ** Found in approximately 1% of cholecystectomy specimens ** Porcelain gallbladder - 2-3% have cancer *** This is probably reflective of long-term inflammation == '''Risk factors''' == * Gallstones present in 70-90% ** Large stones (>3cm) seem to give a ten-fold increase in risk compared t...") Tag: Visual edit
05:35, 30 June 2025 SurgopaediaAdmin talk contribs created page Gallbladder polyps (Created page with "Outgrowths of the gallbladder mucosal wall == '''Pathophysiology''' == * See separate topic of 'gallbladder cancer' - suspected adenoma-carcinoma sequence involving polyps * The only polypoid lesions that have malignant potential are adenomatous polyps == '''Classification''' == === '''Benign''' === ** '''Cholesterolosis/cholesterol polyps''' *** Accumulation of lipids in the mucosa of the gallbladder wall *** Diffuse (cholesterolosis) or polypoid (cholesterol polyp...") Tag: Visual edit
05:33, 30 June 2025 SurgopaediaAdmin talk contribs created page Sphincter of Oddi dysfunction (Created page with "Encompasses ''sphincter of Oddi stenosis'' and ''sphincter of Oddi dyskinesia'' == Epidemiology == * Biliary SOD is mostly seen in post-cholecystectomy patients, and sometimes referred to as 'post-cholecystectomy syndrome' ** GB may have previously served as a reservoir to accommodate increased pressure, then unmasking sphincter dysfunction when it was removed ** However still only seen in <1% of patients post-cholecystectomy * Pancreatic SOD is apparently found quite...") Tag: Visual edit
05:30, 30 June 2025 SurgopaediaAdmin talk contribs created page Functional gallbladder disorder (Created page with "Previously called biliary dyskinesia == Pathophysiology == * GB dysmotility - creates pain in the absence of gallstones * Has been associated with abnormal colonic transit and gastric emptying == Presentation == * Classic biliary colic, but with no gallstones or sludge == Diagnosis == * Diagnosis of exclusion ** USS ** Repeat USS with special attention to GB infundibulum and Hartmann's pouch and phrygian cap ** Gastroscopy ** ?Bile microscopy for microcystal diseas...") Tag: Visual edit
05:28, 30 June 2025 SurgopaediaAdmin talk contribs created page Cholecystitis (Created page with "Either calculous or acalculous Category:Biliary") Tag: Visual edit
05:26, 30 June 2025 SurgopaediaAdmin talk contribs created page Acalculous cholecystitis (Created page with "Blockage of the cystic duct in the absence of stones == '''Epidemiology''' == * Accounts for 5% of cholecystitis * Typically occurs in critically unwell patients, but certainly CAN occur in otherwise well patients, although they usually have risk factors == '''Risk factors''' == === Anatomical === ** Ampullary stenosis ** Choledochal cyst ** Cystic duct obstruction by some sort of CBD stent/PTC ** Metastases to porta hepatis === Acute events === ** Critical illnes...") Tag: Visual edit
05:16, 30 June 2025 SurgopaediaAdmin talk contribs created page Acute cholangitis (Created page with "Also called acute cholangitis or ascending cholangitis == '''Risk factors:''' == * Smoking * Older age * Biliary instrumentation * Any risk factor for cholelithiasis == '''Aetiology''' == * Stones (28-70%) ** Distal obstruction is mostly stones, whereas proximal obstruction is mostly malignancy or recurrent pyogenic cholangitis (primary choledocholithiasis) * Malignant strictures (10-57%) ** Pancreatic cancer ** Cholangiocarcinoma ** GB adenocarcinoma ** Ampullary ca...") Tag: Visual edit
05:15, 30 June 2025 SurgopaediaAdmin talk contribs created page File:Cholangitis diagnostic criteria.png
05:15, 30 June 2025 SurgopaediaAdmin talk contribs uploaded File:Cholangitis diagnostic criteria.png
05:14, 30 June 2025 SurgopaediaAdmin talk contribs created page File:Cholangitis severity grading.png
05:14, 30 June 2025 SurgopaediaAdmin talk contribs uploaded File:Cholangitis severity grading.png
03:10, 30 June 2025 SurgopaediaAdmin talk contribs created page Gallstone disease (Created page with "== '''Epidemiology''' == * 10-15% of Americans in lifetime * 80% will be asymptomatic == '''Risk factors''' == * Obesity * Female * 30-50yo * Rapid weight loss (seen in 30% of patients after bariatric surgery, which can possibly be reduced by daily ursodeoxycholic acid) * Pigment stones - haemoglobinopathies (sickle cell, hereditary spherocytosis, thalassaemia, CF, cirrhosis, Crohn's) == '''Pathophysiology''' == === Cholesterol stones === ** Bile salts and lecithin...") Tag: Visual edit
03:01, 30 June 2025 SurgopaediaAdmin talk contribs created page Acute calculous cholecystitis (Created page with "A '''complication''' of gallstone disease == '''Epidemiology''' == * Occurs in 10% of patients with gallstones over a 10 year period == '''Pathophysiology''' == * Outflow obstruction of GB which does not resolve, leading to a stagnant pool of bile. Increased pressure leads to inflammation with oedema and sub-serosal haemorrhage. * Requires bile stasis and presence of an irritant (not fully understood what this irritant is) * Inflammatory mediators propagate the infla...") Tag: Visual edit
20:44, 29 June 2025 MediaWiki default talk contribs created page Main Page