Intussusception trivia

Some mnemonics are useful and others are just plain trivia. Here is some intussusception trivia that is easy to remember:

  • In adults, a cause may be found in 2/3 of cases
  • 2/3 of known causes will be due to neoplasm
  • 2/3 of these neoplasms are malignant

This is why some may prefer to resect an intussusception in an adult (as opposed to reduce it as is done in children).

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Source: This bit of trivia was found in Skandalakis’ Surgical Anatomy.

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The F word

As the title of the post suggests, this week’s post will take a turn towards the arguably-not-so-PC. If you don’t like one of the F words of this week’s mnemonic, I provide a more PC alternative. :)

When suspecting obstructive biliary disease, think of the 5 factors that describe the patient population frequently affected by gallbladder disease. These 5 factors are remembered with the “5 ‘F’s”

Fair

Female

Forty

Fertile

Fat (or use the more polite term “full”)

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Congratulations to the Canadian 4th year medical students on the residency Match!! Good luck to the Americans!

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Scoring and risk stratification (part 5)

The Alvarado score is a popular score used in emergency medicine to determine the likelihood of an appendicitis. This score is a high sensitivity for appenciditis and is therefore best for ruling it out (sensitivity of a score of 5 is 99% and specificity of a score of 7 is 81%). It is unreliable in children and more reliable in men than women. You may refer to a systematic of the Alvarado score below.

The Alvarado score has 8 criteria for a total score of 10 points. Alvarado score may be remembered using the following memory trick: “My Appendix Feels Likely To Rupture Now”.

My = Migration of pain to the right iliac fossa

Appendix = Anorexia

Feels = Fever of 37.3 Celsius or more

L = Leukocytosis

T = Tenderness in the right iliac fossa

R = Rebound tenderness

N = 1) Nausea or vomiting 2) Neutrophilia

**Tenderness in the right lower quadrant and leukocytosis count for 2 points each. All other criteria count for 1 point.

A score of 1 to 4 points has a 30% probability of being appendicitis. No imaging is suggested (note: if score is 4 points and there is clinical suspicion, imaging is suggested). The patient may be discharged.

A score of 5 to 6 points has a 66% probability of being appendicitis. A CT of the abdomen is suggested. The patient should be observed +/- admitted.

A score of 7 to 10 points has a 93% probability of being appendicitis. Consult a surgeon.


Please refer to this article by Ohle et al. entitled “The Alvarado score for predicting acute appendicitis: a systematic review” for more reading. Thanks for reading!

*Note: this tool (and other risk stratification tools posted on this blog) is only for use by medical professionals in the medical context. If you are concerned for your health, please consult your physician!

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Triads, pentads and classic presentations (part 10)

So the “Triads, pentands and classic presentations” series has reached its 10th post! Just when you thought all the good ones were already posted here, here is another one!

Borchadt’s triad for gastric volvulus:

1) severe epigastric pain

2) retching without vomiting

3) inability to pass a nasogastric tube

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Have a great week! Good luck to those writing their pre-holiday university exams.

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Healing

This week we present two mnemonics related to non-healing. “FETID” provides a differential for a non-healing fistula and “TIME” is handy mnemonic to know when dealing with a chronic wound.

FETID for fistula*

F = Foreign body

E = Epithelialization if the fistulas tract

T = Tumor

I = Infection/Inflammation

D = Distal Obstruction

TIME for non-healing wound*:

T = Tissue is non-viable or deficient

I = Infection or Inflammation

M = Moisture imbalance (i.e. too dry or too wet)

E = Edge of is wound is non-advancing or undermining

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FETID was taken from Pestana’s surgical notes and TIME was taken from the following link.

Triads, pentads and classic presentations (part 9)

Happy Thanksgiving to Canadian readers!

This week TheWM presents part 9 of the Triads series. Today we present Leriche Syndrome and the Trauma Triad of Death.

  •  Leriche syndrome, also known as aorto-iliac occlusive disease exhibits a triad of: 1) claudication of the buttocks and thighs 2) femoral pulses which are decreased or not palpable 3) impotence in males.
  • The Trauma Triad of Death describes a state found in trauma patients (sustaining severe injuries) associated with a high mortality if not corrected: 1) coagulopathy 2) metabolic acidosis 3) hypothermia

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The Weekly Mnemonic is approaching 10, 000 views. Stay tuned, because some time after that benchmark, The WM will change its look and just might offer a prize to one of its followers! Have a great week.

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Fissures

TheWeeklyMnemonic is back with two mnemonics related to anal fissures. The first is the “classic fissure triad” for the findings on physical examination of patients with chronic anal fissures. The second is the “WASH” regimen for the treatment of anal fissures. (These memory aids have been obtained from this Medscape article):

Classic fissure triad:

1) Deep ulcer

2) Sentinel pile (may appear as a skin tag once resolved)

3) Enlarged anal papillae

“WASH” mnemonic for the treatment of fissures:

W= Warm water/sitz bath after each bowel movement

A = Analgesics

S = Stool softeners

H = High fiber diet

Approximately 50% of anal fissures will heal in 2-4 weeks with conservative management.

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