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Only registered users can write reviews. Please, log in or register. All Categories. Allied Health Sciences. Medical Sciences. Manthappa may be a lifesaver if you're beginning your medical theoretical preparation late in your final year like the last two months or so.
Almost everything you'll need for the theoretical test is written in plain English that even an eighth-grader can understand. Furthermore, the subject is kept to the point, and the book only discusses what is absolutely necessary. The presentation of the material is given in a logical way, which is the cherry on top.
When reading a book like Manthappa, it is simple to connect the dots and comprehend the topic as a whole. Add 2 Items to Cart. Rate Product. Very good and useful medical manual for ICU pattient care doctors. Flipkart Customer Certified Buyer , Hassan.
Flipkart Customer Certified Buyer , Bareilly. Really use full book medical students and doctors very helfull. Flipkart Customer Certified Buyer , Bengaluru. Marjolin's ulcer see page Because of their contractile elements, they are called myofibroblasts. Wound contraction readily occurs when 1. Primary suturing: Suturing the wound within a few hours there is loose skin as in back and gluteal region. Skin following an injury six hours is ideal is called primary suturing.
Wound healing Day days hours days. If a wound is sutured in the presence of infection, the suture material is eaten away digested by organisms which results in gaping of the wound.
Wound with skin loss Fig. Wound excision and primary suturing of skin: This is procedures or accidents, etc. Aim is to convert an untidy wound into a tidy wound. This type of suturing is called as secondary suturing. Saline is increasingly being used to wash the wound as H2 02 and betadine may cause more damage. Age: In children, wounds heal faster. If there is no old age.
Dermal collagen content decreases with aging. This Also, collagen fibres show distorted architecture and two-stage procedure is called delayed primary suturing. Debilitation results in malnutrition. Wound healing is Local factors delayed probably because of vitamin C deficiency.
Poor blood supply: Wound over the knee and shin of tibia Following injury, vitamin C deficiency can occur after heals very slowly but wound on the face heals fast. Vitamin C is necessary for the synthesis and maintenance of collagen. Zinc deficiency is known to 2. Local infection: Organisms eat away the suture material, delay the healing of pilonidal sinus. Zinc deficiency is destroy granulation tissue and causes slough and purulent rare-it occurs in large burns, severe polytrauma and discharge.
In diabetic patients, wound healing is delayed because of wound does not heal. Collagen synthesis is reduced and several factors such as microangiopathy, atherosclerosis, collagenolysis is increased.
Antibiotics should be given decreased phagocytic activity, proliferation of bacteria due immediately or within 2 hours to prevent infection. Key Box 1. Jaundiced and uraemic patients have poor wound healing 3.
Haematoma precipitates infection. Faulty technique of wound closure. Cytotoxic drugs such as doxorubicin and malignancy 5. Tension while suturing.
Hypoxia: Killing property of macrophages and production of fibroblasts can decrease due to hypoxia. Ionising radiation: It causes endothelial cell injury with endarteritis and results in atrophy and fibrosis.
Corticosteroids given early may delay wound healing oedema of the region. Malnutrition: Definitely results in delayed wound healing including intestinal anastomotic leakage and wound dehiscence. The most prone site is the anterior compartment. Clinical features found. Caucasians Key Boxes 1. It is ln crush injuries who present late to the hospital, it is safer to do amputation because by doing fasciotomy sudden release the commonest site for a keloid. It is extremely difficult to of myoglobin from dead muscle may cause systemic treat the keloid over the sternum.
We had one patient who myoglobinuria, glomerular blockage and renal failure. Jaw, vaccination are common sites Figs 1. Blood vessels are minimal When scar crosses 'joints or flexion creases, a tight 'web' may in this condition. However, in keloid, proliferation of form which is referred to as a contracture see Bums Chapter immature fibroblasts with immature blood vessels are for more details. General features It occurs from a prolonged inflammatory phase of wound healing. It never gets worse after 6 months.
If present, it is not severe. Hence the name. Recurrence is common. Collagen bundles are virtually absent in keloid. It is extremely difficult to treat a keloid. Mastectomy 2 Staphylococcus Fig. Elective surgery Gastrointestinal, Vascular procedures Thyroidectomy aureus. Hysterectomy Cholecystectomy entered. Open, fresh, traumatic wounds Ruptured appendix 20 Depends on underlying cause Fig.
Minor break in sterile technique Dirty Fig. The 'ebb phase' begins immediately following surgery and lasts for 24 to 48 hours. This phase aims to conserve circulating fluid volume and energy. The 'ebb phase' is characterised by hypovolaemia, hypothermia, reduced basal metabolic rate BMR , reduced cardiac output and lactic acidosis. Renin-angiotensin cascade is an important component of the 'ebb phase'.
The hormones responsible are adrenal hormones, i. The 'flow phase' follows the 'ebb phase'. This phase is concerned with recovery and repair following the initial injury. The 'flow phase' is subdivided into catabolic Fig.
The catabolic phase is associated with increased levels of catecholamines, cortisol, insulin and glucagon. Following issues are important aspects of metabolic response to stress. This condition has been termed as 'critical illness myopathy'. Changes in liver protein metabolism Injury Normally liver synthesises two types of proteins: 1.
Structural proteins Nociceptive receptors. During stress, liver synthesises 1. Positive acute phase reactants, e.
Hypothalamus 2. Negative acute phase reactants, e. Albumin and its clinical significance Sympathetic system Albumin is the major protein synthesised by liver. This might not be true. Serum level of albumin is governed by rate of synthesis and transcapillary escape rate. Cortisol During stress, transcapillary escape rate of albumin increases by about 3 times. This is because of increased microvascular Fig. Neuroendocrine response Fig.
The neuroendocrine pathway starts with nociceptive receptors involves spinal cord, Innate immune system Adaptive immune response thalamus, hypothalamus and pituitary. ACTH acts on adrenals to increase the secretion of cortisol. The - The pro-inflammatory cytokines are interleukin- I IL-1 , initial response to injury is pro-inflammatory and results are tumour necrotic factor-a, interleukin-6 IL-6 , and interleukin- such as pyrexia, proteolysis, propagation, productions.
Such counter. Unopposed pro-inflammatory response Hormones whose levels rise following injury: leads to "Systemic immune response syndrome". Platelet aggregation occurs in which phase of the C. Diagnostic feature is paraesthesia between 1st an wound healing? Inflammatory phase D. Compartment pressure greater than 30 mm of H B. Proliferative phase is an indication for urgent fasciotomy C.
Remodelling phase 6. Following are true for keloid except: D. Scar formation phase A. It extends into normal skin B.
It continues to become worse even after several 2. Chronic scar can change into: years A. Martorell' s ulcer C. It does not give rise to itching B. Marjolin' s ulcer D. It recurs often after excision C. Meleney' s ulcer 7. Following are true for hypertrophic scar except: D. Malignant melanoma A.
It does not extend into normal skin 3. The ideal solution to wash the wound is: B. It does give rise to itching A. Saline C. It becomes worse even after 2 years D.
It is more common in blacks B. Betadine C. Hydrogen proxide 8. Eusol A. Sternum is one of the common sites for keloid B. Collagen bundles are present in keloid 4. Following facts are true in wound healing except: C. Intrakeloidal injections can be used to treat A. Vitamin C is necessary for synthesis of collagen D. Deep pigmented skin is more vulnerable fo1 B.
Diabetic patients have decreased phagocytic keloid activity 9. Which hormone level does not rise during injury'i C.
Once healing is established, corticosteroids can be A. ACTH given B. Adrenaline D. Poor wound healing in jaundiced patients is due C. Glucagon to poor functioning of macrophages D. Thyroxine Albumin level decreases during stress because of: 5. Following are true in compartment syndromes A. Decrease production except: B. Decrease intake A. Usually occur in the lower limbs C. Liver failure B.
Most prone site is posterior compartment D. Increased microvascular permeability. However, infection still dominates and it is one of the major causes of mortality and Clinical features morbidity in a patient who has a 'benign disease'.
This is the The affected part shows evidence of inflammation such as sad part of consequence of disease. Hence, it is important to redness and itching followed by diffuse swelling. Skin is diagnose and treat infections effectively as early as possible. Pain, fever, toxaemia follow later.
It is differentiated from an abscess by features mentioned in Key Box 2. Cellulitis is a spreading subcutaneous inflammation caused b y haemolytic Streptococcus.
Streptococci produce hyaluronidase and streptokinase. Net result is that the inflammatory exudate spreads in the subcutaneous and fascia! Wherever there is loose subcutaneous tissue, as in scrotum or loose connective and interstitial tissue as in face and forearm, it spreads fast. This reduces oedema of legs. Submandibular gland is mobilised, mylohyoid muscle is divided and the pus is drained.
Complications Even if pus is not found, the oedematous fluid comes oul l. Cellulitis can turn into an abscess which needs to be greatly improving the condition of the patient. Wound is drained. Necrotising fasciitis: Certain highly invasive strains of antiseptic agents and a drainage tube is kept in place. Streptococcus pyogenes can cause extensive necrosis of skin, subcutaneous tissues and may result in necrotising Complications fasciitis.
It is treated by debridement and skin grafting later I. Mediastinitis and septicaemia see page Oedema of the glottis due to spread of the cellulitis via a 3. Toxaemia and septicaemia: Streptococcal toxic shock tunnel occupied by stylohyoid to submucosa of the glottis. Cellulitis can precipitate ketoacidosis in a patient who has diabetes mellitus. Anaerobes also play a common. Tender, painful lymph nodes in the groin are major role Key Box 2.
Rubor-redness: It is due to inflammation resulting in hyperaemia. Pyogenic abscess: It is the commonest form of an abscess. It can be subcutaneous, deep or can occur within the viscera 3. Dolor-pain: An abscess is extremely tender.
In this chapter, pyogenic abscess 4. Tumour-swelling: It consists of pus. It is tensely cystic refers to soft tissue abscess. Pyaemic abscess: Occurs due to circulation of pyaemic 5.
Loss of function: The function of the part is impaired, due emboli in the blood pyaemia. Cold abscess: Usually refers to tubercular abscess due to 6. Fluctuation: It can be elicited. However, in a deep-seated involvement of either lymph nodes or spine. It can also be due to haematogenous spread from a skin, gut, oral cavity. However, deep-seated abscess such distant focus such as tonsillitis or caries tooth. Pyogenic as breast abscess may cause much tissue destruction before abscess can also be due to cellulitis.
Pathological events are summarised in Fig. The pus which comes out is collected infiltrated with leukocytes and bacteria. It is called pyogenic and sent for culture and sensitivity. A sinus forceps or a membrane. Fresh oozing of the pus is an Symptoms indication of completion of the procedure.
The abscess The patient feels ill and complains of throbbing pain at the cavity is irrigated with saline or mild antiseptic agents such site. Throbbing pain is indicative of pus and is due to pressure as iodine solution or hydrogen peroxide. Hydrogen peroxide on the nerve endings by the pus. Fever, with or without chills acts by liberating nascent oxygen. Calor-heat: The affected part is warmer due to local rise the slough.
The cavity, if large, may need to be packed in temperature. Permeability Reticuloendothelial response Bacteriology. Exudation of protein Macrophages and polymorphs Release of toxins and enzymes. Fibrin formation Release of lysosomal enzymes Tissue destruction. Roller gauze packing prevents fibrosis, resulting in thickening of the abscess wall. Clinically the premature closure of the skin, thereby facilitating the this may result in a hard lump.
With appropriate antibiotics etc. Antibioma in the breast may mimic carcinoma of the breast. Dosage: mg, 6th hourly for days. This method is pyaemia. It is the systemic effect of sepsis. It commonly followed where an abscess is situated in the vicinity of occurs in diabetics and patients receiving chemotherapy and important anatomical structures such as vessels or nerves radiotherapy.
Pyaemic abscess is characterised by following Table 2. Hence, it is called nonreactive abscess to differentiate it from pyogenic abscess. This is treated by multiple incisions Relationship of nerves or vessels with an over the abscess site and drainage like a pyogenic abscess abscess with antibiotic cover.
Usually, it is due to tuberculosis, e. Save my name, email, and website in this browser for the next time I comment. Friday, February 3, Medicos Republic. Free Medical Books Download Surgery. Table of Contents.
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