Lymphatic drainage of thyroid gland and lymph node levels in neck

Lymphatic System of Thyroid

Lymph node levels of neck

Source of Nodal metastasis in neck

Classification of nodal dissections of neck

Types of MRND

Indication of prophylactic neck dissection in thyroid ca

Indication of prophylactic neck dissection in thyroid ca 2

 

4/02/2016 12:22:00 AM

A 25 year old primi with history of 4 months amenorrhoea presented with sudden onset abdomen pain and distention over past 2 days. On examination she had significant tachycardia and she was febrile. There was generalized guarding and rigidity present over the abdomen along with rebound tenderness suggestive of peritonitis. There ere no abnormal findings on PR.

6/08/2015 01:58:00 PM

A 35 year old male presented with abdominal pain, cramping, abdominal distension and multiple episodes of vomiting. X ray revealed dilated small bowel loops with multiple air fluid levels. The vitals of patient were stable and showed no signs of strangulation. The patient was initially managed conservatively with analgesia, intravenous fluids, nasogastric suction and an indwelling urinary catheter. But even after a day of conservative therapy the symptoms were not relieved and an exploratory laprotomy was done to reveal a dense adhesion kinking the small bowel around its axis.

Abdominal Adhesions: Important Points

1. Opening the peritoneal cavity, in whatever type of surgery, leads to the formation of potentially obstructive structures (adhesions or bands) in almost 95% of patients.[1]
2. Today, with the increased incidence of abdominal surgery, these structures are the most frequent cause of small bowel obstruction (SBO)- almost over two third cases of SBO caused by adhesions.[2]
3. Although most adhesions cause no symptoms or problems, others cause chronic abdominal or pelvic pain. Adhesions are also a major cause of intestinal obstruction and female infertility.
4. Abdominal Adhesions and Female Infertility: Abdominal adhesions can lead to female infertility by preventing fertilized ova from reaching the uterus. Women with abdominal adhesions in or around their fallopian tubes have an increased chance of ectopic pregnancy.

References

1] Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.
Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O'Brien F, Buchan S, Crowe AM
Lancet. 1999 May 1; 353(9163):1476-80.
2]Miller G, Boman J, Shrier I, et al. Etiology of small bowel obstruction. Am J Surg. 2000;180:33–36

5/26/2015 08:21:00 PM

-A 50 year old male was admitted with complaints of  intermittent fevers, cough, anorexia and general malaise since 8 weeks. The patient was a known Chronic alcoholic and a chain smoker. There were no positive findings on fever workup and general investigations except that hemoglobin was 9.1 g/dl  and ESR was elevated. USG Abdomen revealed a large liver abscess. Empirical antibiotics were started.

-CECT Abdomen showed an enlarged liver with 10x9 abscess in the right lobe superior segment along with two small abscesses noted in segment VI, each measuring 3x3cm. Intrahepatic billiary radicles, portal vein, porta hepatis appeared normal. There was no evidence of periportal lymphadenopathy

-BT/CT and PT/INR were within normal limits. USG guided pigtail catheter placement and drainage was done.

Discussion

Duration of antibiotic therapy?

-Currently 4-6 weeks of therapy is recommended for solitary lesions that have been adequately drained.

-Multiple abscesses are more problematic and can require up to 12 weeks of therapy. Both the clinical and radiographic progress of the patient should guide the length of therapy.

Intervention Plan?

-Although the primary mode of treatment of amoebic liver abscesses is medical, 15% of amoebic abscesses may be refractory to medical therapy. 

-Also, secondary bacterial infection may complicate up to 20% of amoebic liver abscesses and hence drainage may be required in many patients with amoebic liver abscesses. 

-Percutaneous drainage is now considered the treatment of choice for most intra-abdominal abscesses and fluid collections.

5/26/2015 12:12:00 AM

• A patient who came with history of fall while boarding a running local train under effect of alcohol
• He was brought to the hospital after 2 hours of injury by the local police 
• When he came he was very restless and agitated
• There were no signs suggestive of any head injury
• Only sign we were able to elicit was marked tenderness over Right side of chest
• There were no obvious dilated veins over the neck, though a slight tracheal deviation was present
• A chest xray showed
• -Over expanded Right hemithorax
• -Shift of the mediastinum to the left side
• -Depression of the Right hemidiaphragm
• SPO2 was 78%. Immediately a needle thoracostomy was done. The SPO2 increased to 94%.
• An intercostal drain with under water seal was inserted.

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5/22/2015 07:39:00 PM

-A 32 year old female presented with chronic RIF pain not associated with fever.

-Ultrasonography (USG) and computerized tomography (CT) demonstrated a well demarcated, elliptical 5 cm × 2 cm cystic mass in the RIF.

-Surgical exploration revealed the mass to be an Appendicular Mucocele. Simple appendectomy was performed. 

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5/19/2015 06:38:00 PM