breast tumor, GB stones and haemorrhoid

went to the OT again yesterday.
saw 3 cases.

1. Breast tumor, fibroadenoma.
"Dr, whats the most common benign tumor of the breast?" -- Fibroadenoma
"kalau malignant?" -- Ductal Ca
and the doctor also shared a piece of info about biopy..
"Biopsy ada 4 jenis.. 1 is incisional.. u amek sikit saja.. 2 is excisional where you u excise the whole thing.. 3rd is fine needle aspiration (FNAC) and 4th is frozen section.. you take a biopsy and send it to the patho lab immediately while the patient is still under anesthesia. if the biopsy comes out +ve, then proceed"

2. gallstone.

• normally when you open up the abdomen, the omentum or the liver is not stuck to the gallbladder (GB) but if there's inflammation (cholecystitis), its gonna get stuck to both liver and omentum.
• nowadays can remove GB (cholecystectomy) by laporoscopy, but when it gets complicated, open up lor. if nak buat chole, buat Kocher's Incision (subcostal) on the right side.
• Besides Kocher's, boleh buat right upper midline/ right upper paramedian/ right transverse incision of GB.
  
• pre-op, obviously kena buat liver function test.

• so kalau direct bilirubin high, therefore its obstructive jaundice la kan~ tapi dalam patient ni tak nampak jaundice dia, cuz its visible only if the reading is >100 U/la success!
  

3. and the last one was haemorrhoidectomy!

• haemorrhoid (a.k.a piles) is mainly due to constipation
• common site? bayangkan bentuk jam tu macam anus, 3,7 and 11 o'clock -- common sites.
  
• the patient will complain of painless bloody defecation
• yes haemorrhoid is totally painless, UNLESS if its thrombosed.
• pain during berak ada 2 je diagnosis : anal fissure (usually tear at 6 o'clock) or thrombosed haemorrhoid.
• 
• this is the stapler used during this procedure. yea susah sket nak imagine. but if you see the op itself, baru ble faham~

next post will Insya Allah be about ECG~ since sem 7 is about cardiothoracic~ @_@