MRCS Part A: Essential Revision Notes: Book 2 - download pdf or read online

By Catherine; Chalmers, Claire Ritchie Parchment Smith

ISBN-10: 1905635834

ISBN-13: 9781905635832

Offers the main up to date fabric, matching the MRCS syllabus, to assist instruction for the MRCS A examinations. The publication covers each significant topic within the MRCS syllabus; works systematically via each basic surgical subject prone to seem within the examination; highlights very important rules of surgical procedure; includes very important lists and very important issues; is obviously laid out with illustrations to assist figuring out.

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Extra resources for MRCS Part A: Essential Revision Notes: Book 2

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Suitable for day case? Urgent or emergency repair? Crural, inguinal or extraperitoneal approach? • Social circumstances for discharge? • Patient must be consented (mention relevant hazards and complications; see below) • The correct side should be marked and shaved • GA cases with comorbidity may need appropriate work-up and anaesthetic review Position: supine. Incision: oblique incision 1 cm below and parallel to the medial inguinal ligament. Procedure • Expose and open the femoral sac in the subcutaneous tissue • Examine contents and reduce into the abdomen • In an elective repair usually only omentum is present • Compromised bowel should never be returned to the abdomen • Once contents are reduced into the abdomen, transfix the sac neck using Vicryl and excise it 1 cm distal to the ligation • Suture the inguinal to the pectineal ligaments for 1 cm laterally with interrupted nylon sutures on a J-shaped needle, tying the sutures only once they have all been placed • Take care to protect the laterally located femoral vein and avoid constricting it Intraoperative hazards • Damage to the femoral vein, bladder or hernial sac contents • Failure to identify Richter’s hernia • Bleeding from an abnormal obturator artery Closure: close subcutaneous tissue using Vicryl; close skin with subcuticular Monocryl Postop: as for inguinal hernia repair although recovery from this approach is usually faster.

8) Superficial inguinal ring: inguinal hernia comes out above and medial to pubic tubercle at point marked (I); femoral hernia below and lateral to pubic tubercle at point marked (F). (9) Symphysis pubis: midline cartilaginous joint between pubic bones. (10) Pubic crest: ridge on superior surface of pubic bone medial to pubic tubercle. (11) Linea alba: symphysis pubis to xiphoid process midline. (12) Linea semilunaris: lateral edge of rectus crosses costal margin at ninth costal cartilage (tip of gall bladder palpable here).

Incision: oblique incision 1 cm below and parallel to the medial inguinal ligament. Procedure • Expose and open the femoral sac in the subcutaneous tissue • Examine contents and reduce into the abdomen • In an elective repair usually only omentum is present • Compromised bowel should never be returned to the abdomen • Once contents are reduced into the abdomen, transfix the sac neck using Vicryl and excise it 1 cm distal to the ligation • Suture the inguinal to the pectineal ligaments for 1 cm laterally with interrupted nylon sutures on a J-shaped needle, tying the sutures only once they have all been placed • Take care to protect the laterally located femoral vein and avoid constricting it Intraoperative hazards • Damage to the femoral vein, bladder or hernial sac contents • Failure to identify Richter’s hernia • Bleeding from an abnormal obturator artery Closure: close subcutaneous tissue using Vicryl; close skin with subcuticular Monocryl Postop: as for inguinal hernia repair although recovery from this approach is usually faster.

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MRCS Part A: Essential Revision Notes: Book 2 by Catherine; Chalmers, Claire Ritchie Parchment Smith


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