both ends of the bowel blocked and nowhere for fluid and gas to egress

suggest a systemic process (infectious, malignant, or autoimmune) such as tuberculosis, lymphoma, leukemia, HIV, or sarcoidosis.

새로운 breast mass에 모두 시행. physical examination imaging tissue sampling

This is typically done by placing the patient in slight Trendelenburg position, providing some sedation and analgesia, applying a cold compress, and then attempting gentle manual compression. The advantage of reduction is that it converts an emergent procedure into a semi-elective one and makes the operation easier as there will be less inflammation. If the hernia is not reducible, urgent surgical intervention is required.

indirect congenital. direct acquired.

Factors that depress immunity and/or decrease tissue perfusion increase the risk for NSTI including diabetes mellitus, malnutrition, intravenous (IV) drug abuse, obesity, chronic alcohol abuse, chronic lymphocytic leukemia, chronic steroid use, renal failure, peripheral arterial disease, and cirrhosis.

liver chemistry, alkaline phosphatase, plane x ray 다른 검사는 symptom 있거나 검사 결과 이상할 때 단 stage III 이상이면 CT 다찍어보고 bone scan도 한다.

Further screening workup should include a chest X-ray, complete blood count, liver function tests, and serum lactate dehydrogenase (LDH) to rule out metastatic disease.

Lymph node dissection is reserved for patients with clinically palpable lymphadenopathy or those with a positive SLNB.

metastatic cancer from a local source (melanoma, anal, or genital cancer).

peritoneum

patent processus vaginalis에서 peritoneal fluid가 scrotum을 채움.

In general, LBO causes gradually increasing abdominal pain, progressive distention, constipation, and occasionally feculent vomiting. There are longer intervals between episodes of cramping pain, and there is more pain in the suprapubic area with LBO than with SBO. 

Large non-tender lymph nodes limited to the inguinal region suggest metastatic cancer (melanoma, anal, or genital cancer) (testicular cancer does not usually metastasize to the groin; it more commonly travels to the retroperitoneum)

Lymphadenopathy (reactive), mononucleosis (EBV), abscess, sarcoidosis, lymphogranuloma venereum

Protrudes through the abdominal wall (Hesselbach’s triangle), medial to the inferior epigastric artery

cellulitis는 항생제만 주면 되지만 NSTI는 debridement 필요. low serumNa or very high WBC가 NSTI suggestive. LINEC score 중요.

Crepitus implies the presence of gas within the tissues, most likely due to the presence of gas-forming organisms.

Indirect inguinal hernias originate lateral to the inferior epigastric vessels, while direct inguinal hernias pass medial within Hesselbach’s triangle. Indirect inguinal hernias travel through the internal ring along with the spermatic cord.

surgical exploration. 이는 치료의 gold standard 이기도 하다.

presence of mydriasis, rhinorrhea, and diaphoresisin those presenting with opioid withdrawal.

volume depletion 있으므로 resuscitation 해주고 nasogasteic tube 줘서 air fluid level 제거하여 각종 증상 줄인다

Passes through the femoral canal, into empty space medial to femoral vein

an autosomal dominant disorder characterized by multiple dysplastic nevi with increased risk for progression toward melanoma (10% risk). These patients have a family history of melanoma, 100 or more moles, and at least 2 large dysplastic nevi.

abdominal wall defect, hernia sac which protrudes through the defect, and contents within the sac.

Pleomorphic subtype of LCIS is considered an aggressive subtype. As such pleomorphic LCIS needs an excisional biopsy with negative margins but does not require additional treatment (such as radiation) unless an invasive component is found.

High probability of malignancy Represent casts of the ducts (“casting” type) in which they lie; often associated with comedo subtype of intraductal carcinoma, typically high grade or poorly differentiated

There are four boundaries: axillary vein (superior), floor of the axilla (posterior), latissimus dorsi muscle (lateral), and pectoral minor muscle (medial).

High probability of malignancy. Classified as BI-RADS 5; typically associated with DCIS

Indications for surgery are persistence beyond age 4, hernia defect larger than 2 cm in diameter (unlikely to close spontaneously), strangulation, or progressive enlargement after 1–2 years of age.

Hematoma, femoral aneurysm, or pseudoaneurysm

ER PR HER-2

Lobular carcinoma in situ (LCIS) is characterized by malignant epithelial cells that arise from the lobules and terminal ducts of the breast.

one must consider syphilis, chancroid, and lymphogranuloma venereum.

severe abdominal pain and/or localized tenderness continuous abdominal pain fever leukcytosis tachcardia peritoneal sign acidosis absence of bowel sound

suspicious calcification. Without a clearly defined shape or form; small and hazy appearance

Melanoma originates from melanocytes, which are derived from neural crest cells. It can arise from a preexisting nevus or de novo as a new pigmented lesion (although a small percentage can be amelanotic).

Current recommendations are that a second-look operation should be scheduled 24 hours after the initial debridement to ensure that the infection has not reemerged. Patients may require multiple reoperations after the initial debridement.

Thicker lesions, ulceration, location on trunk, and male gender