~Teachingcenter的醫學筆記~

闌尾炎、膽囊炎、腹股溝疝氣、乳房手術

術前診斷：RLQ peritonitis, suspect Appendicitis
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable、no subphrenic free air
   EKG：normal sinus rhythm
PE：
   Abdomen：
     RLQ local tenderness with muscle guarding and rebounding pain, esp. McBurney’s point
     mild hypoactive bowel sound, no shifting dullness
     OP scar：No or Yes：_____ and where ____
     Rovsing's sign：( - )
   Psoas sign：( - )
     Obturator sign：( - )
OP indication：
  RLQ local peritonitis, acute appendicitis was highly suspected

Laboratory data：
Treatment plan：
  1. Arrange urgent appendectomy, try laparoscopic approach firstly
 2. NPO
 3. Empiric IV antibiotics use (if no allergy, try cefuroxime + metronidazole)
  4. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Left/Right inguinal hernia
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
 Abdomen：
     soft and flat
     no tenderness  
     ___ cm soft bulging mass at left/right groin region, reducible
OP indication：
     Symptomatic patient
Laboratory data：
Treatment plan：
     1. Arrange Lichtenstein tension-free hernioplasty
     2. NPO after midnight prior to the day of surgery
     3. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Gallbladder stones with cholecystitis
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
 Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
    Abdomen：
      soft, flat/distended
      mild tenderness at RUQ
      Murphy's sign：( - )
      normoactive/hypoactive bowel sound
      OP scar：No or Yes and where ____
OP indication：
     Symptomatic patient
   Failure of conservative treatment
Laboratory data：
Treatment plan：
     1. Arrange laparoscopic cholecystectomy
     2. NPO after midnight prior to the day of surgery
     3. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family
     4.目前約有八至九成的膽囊病變可使用腹腔鏡膽囊切除術，在普通膽囊病變，其成功率達95%以上，但有時因沾黏、腫瘤較大、出血或解剖構造不易辨別等有安全上的疑慮時，必須改變手術方式為傳統開腹手術補救之，如：在急性膽囊炎其轉換率可達30%以上

術前診斷：Left/Right breast neoplasm favor fibroadenoma

Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm

PE：
    Neck：supraclavicular LN：no enlargement
    Breast：
      Nodule：size：  *     cm
        location：   o'clock   cm from left/right nipple
         shape：oval
         border：well-defined
         consistency：soft
         mobility：movable
         tenderness：mild tenderness
    Skin change：Nil
    Nipple change：nil
    Axilla node：impalpable
OP indication：
     Growing or Symptomatic tumor
Laboratory data：
Treatment plan：
     1. Arrange excision of breast tumor
     2. NPO after midnight prior to the day of surgery
     3. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Left/Right breast microcalcification
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
   MMG：cluster microcalcifications at left/right breast
PE：
   Neck：supraclavicular LN：no enlargement
   Breast：
     Nodule：impalpable by clinically
   Skin change：nil
   Nipple change：nil
   Axilla node：impalpable
Impression：
   Left/Right breast microcalcification, suspicious for malignancy
OP indication：
   Suspicion of malignant transformation

Laboratory data：
​​​​​​​Treatment plan：
   1. Arrange MMG-guided stereotactic microcalcifications localization --> partial mastectomy, intra-OP specimen mammogram
  2. NPO after midnight prior to the day of surgery
   3. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Left/Right breast cancer
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
    Neck：supraclavicular LN：no enlargement
    Breast：
       Nodule：size：  *     cm
         location：   o'clock    cm from left/right nipple
         shape：irregular
         border：irregular
         consistency：firm
         mobility：fixed
         tenderness：mild tenderness
    Skin change：Nil
    Nipple change：nil
    Axilla node：impalpable
Laboratory data：
​​​​​​​Treatment plan：
     1. Arrange partial mastectomy + SLBN +/- ALND
     2. Sentinel node scintigraphy, if SLNB indicated.
     3. NPO after midnight prior to the day of surgery
     4. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family