Gen Surg: Quickie Update

Okay so I have a few pics that I gotta post else I'll forget. But thus far, surgery really picked up this last week. All the residents took their in-service exams (specialty specific) and now they mean business. So if it was even possible,  I am even busier than I was before. Now I'm following them to different hospitals, answering consults on my own, and even witnessing political pissing contests between surgeons. I spent a 'short' day on saturday that was as the resident proclaimed it gunna be 'quick and easy.'  And of course I was there for 14 HOURS!! Without lunch. I had a fig newton as dinner. And about 4 cups of coffee. More later.


So about oh 40% of general surgery cases have to do with the gallbladder. There is at least one every other day. SO i might as well document a couple. Usually you get your gallbladder out because you have gall stones or an infection. In the surgery world, most gallbladder removals (cholecystectomy) are done laparoscopically. Thus we call them a 'lap chole' (lap kohl-ie).  WE put in four tiny inch wide incision in the belly then blow up the belly with CO2 gas. Put in something called a port where we can hold open the hole for our long instruments and peel the gallbladder off the liver. Because this surgery is so common, most surgeons keep a log of how long it takes them on average to do a lape chole. This number is what they compare to others to find out if their skills are good, bad or average. Weird I know.  But they don't really have their eye on the clock, at least none of the surgeons i've seen do. The nurses keep track for them. Below is a picture I took of one of my patient's gall bladder's filled with stones, these stones are made of cholesterol. (don't eat at McDonald's kids).

 

Next case is probably best patient of the year. Guy comes in to ER, who has a PEG tube. Its a little hole in your abdomen that has a tube in it so we can feed you without putting food in your mouth. This is usually done for someone who is having trouble swallowing or who is in a coma and can't be eating.  This PEG was in a guy who had suffered a anoxic brain injury from a car crash. He was mentally not with it and he pulled out his PEG tube and ATE IT.  Yeah that's right. He ate his own PEG tube. :D   We crazy docs thought this was just hilariously ironic. We gave him another one and admitted him to the hospital where he pooped it out without a problem. Weird thing is he can totally understand you and follow commands, he just has to be restrained. It should also be mentioned that he ate chunks out of the blanket in the ER, grinds his teeth together (its painful you can tell because of the sound) and constantly licked his arms. This is where several med students and I came up with the phrase "you can lick your arm if you wanna."  which is applicable to any patient who does something stupid but they do it anyway. I think its catching on...   Below is a picture of his PEG tube. Nothing special.