@justageneralsurgeon - Kenichi

I'm just a general surgeon . Real cases, real surgeries. Not just random medical facts like other pages . DM for promos and shadowing opportunities! .
http://www.youtube.com/c/justageneralsurgeon
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Splork! Huge sexy lipoma for your viewing pleasure!
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This was removed off a young woman’s back. It was getting larger and painful. It had been there for several years.
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#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . Splork! Huge sexy lipoma for your viewing pleasure! . This was removed off a young woman’s back. It was getting larger and painful. It had been there for several years. . #surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medst

Kenichi T. Miyata, MD - General Surgeon
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Plastic reconstructive surgery is an important part of trauma. Here is a case of a young male who got hit by a car and dragged on the road on the left side of his head. The left ear was almost completely ripped off. Thankfully, @medstudent_fr was on call and was able to salvage the ear.
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The ear and nose are special parts of the body because they are mostly cartilage, and therefore have limited blood supply. It makes healing and treating infection difficult. Treatment in this case included surgical debridement of devitalized tissues, extensive irrigation, reapproximation of the tissues, and prolonged antibiotics. As you can see, the ear has healed very nicely.
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1-3. Patient presents with left ear avulsion secondary to ped vs car. 
4-5. After debridement and irrigation, the tissues are reapproximated with sutures and a drain in left in place. The top of the ear is dusky and at risk for necrosis. 
6. Three days after surgery, the ear appears to be revascularized and is healing nicely.
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Send me your submissions if you have an interesting case!  @medstudent_fr .
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#surgeon #surgeon #nurse #nurses #doctor #doctors #er #trauma #physician #medstudent #medical #medicalstudent #medschool #plasticsurgery
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. . Plastic reconstructive surgery is an important part of trauma. Here is a case of a young male who got hit by a car and dragged on the road on the left side of his head. The left ear was almost completely ripped off. Thankfully, @medstudent_fr was

Kenichi T. Miyata, MD - General Surgeon
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Hydrocephalus is a devastating condition in which there is an excess of cerebrospinal fluid (CSF). The increase in fluid in a confined space (limited by the skull), can lead to irreversible brain damage. Hydrocephalus can be caused by a number of different reasons. This 4 month old (the first two photos are stock images) had a tumor that was causing an increase in CSF production as well as a decrease in the ability to absorb the fluid.
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1. Large head caused by excess fluid build up.  diseasepictures.com.
2. Pathophysiology  healthjade.com.
3. Pre-op CT axial cuts showing excessive fluid.
4. Pre-op MRI axial and coronal cuts showing the brain tumor (the  looking thing in largest black area - the ventricle).
5. Incredible footage showing how to get into the ventricular space, the tumor, and the tumor removal.
6. Side by side pre and post-op MRI showing the tumor (white arrow on the left) and after surgery. The extra fluid on the post-op image is due to dissection of the layers covering the brain (dura and arachnoid). This fluid gets resorbed and is of no consequence.
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Amazing submission by @martinphammd.
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#surgeon #surgeon #nurse #nurses #doctor #doctors #physician #medstudent #medical #medicalstudent #medschool #brain #tumor
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. Hydrocephalus is a devastating condition in which there is an excess of cerebrospinal fluid (CSF). The increase in fluid in a confined space (limited by the skull), can lead to irreversible brain damage. Hydrocephalus can be caused by a number of d

Kenichi T. Miyata, MD - General Surgeon
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This video shows a patient caring for her ostomy. There are several types of ostomies, which are created when a surgeon creates an opening in a piece of intestine and the abdominal wall to allow drainage of its contents into a bag. Ostomies are created for several reasons including protecting a newly created connection/ anastamosis, infection, or obstruction of the downstream intestine.
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This patient appears to be young and has a ileostomy (an ostomy created from the ileum - the last segment of small intestine). My guess would be that she has Ulcerative colitis or Familial Adenomatous Polyposis (FAP) which are both diseases that can require removal of the entire large intestine. Sometimes it is not possible to connect the small bowel to the rectum so an end ileostomy is created. And yes her ostomy is sticking out longer than normal. Usually it looks like a small “button” that barely sticks out past the skin.
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Submission by @medicine_horror .
#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . This video shows a patient caring for her ostomy. There are several types of ostomies, which are created when a surgeon creates an opening in a piece of intestine and the abdominal wall to allow drainage of its contents into a bag. Ostomies are c

Kenichi T. Miyata, MD - General Surgeon
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This post demonstrates why the most important step of a laparoscopic cholecystectomy is the visualization of the Critical View of Safety! This is where we identify the cystic duct coming off the gallbladder, so you are sure you are cutting the cystic duct and not the common bile duct.
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1. Video - at first glance, it appears to be an easy gallbladder surgery with the cystic duct sitting right there, ready to clip and cut.
2. Video - careful dissection gradually teases out a short cystic duct that is folded over itself, running along the gallbladder. It was completely hidden under the peritoneal layer. 
3. Video - the short cystic duct is clearly demonstrated and is now easily clipped and cut away from the common bile duct on the right.
4. Video - cystic duct is clipped and cut and you can see the stump coming off the common bile duct.
5. First view of the gallbladder.
6. Outline of what a reckless surgeon can confuse as the cystic duct.
7. Critical view of safety.
8. Outline of the critical view of safety. Gallbladder to the left, short folded over cystic duct in the middle, and the common bile duct on the right.
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Board question: what do you do if you cut the common bile duct?
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#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . This post demonstrates why the most important step of a laparoscopic cholecystectomy is the visualization of the Critical View of Safety! This is where we identify the cystic duct coming off the gallbladder, so you are sure you are cutting the cy

Kenichi T. Miyata, MD - General Surgeon
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Acute cholecystitis occurs when a gallstone blocks the cystic duct and does not unblock on its own. This leads to congestion and inflammation, which is very painful. In this case, the gallbladder is so thickened and distended, it could not be grasped initially. It had to be decompressed with a sharp suction device. It is easy to see how a severely inflamed gallbladder is much more difficult and risky to remove than a non-inflamed one. This is one of the main reasons I encourage healthy patients who have symptoms of biliary colic to have their gallbladder removed electively and not wait.
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1. Video showing the inflamed, distended gallbladder. I couldn’t grasp the fundus so I decompressed the gallbladder. 
2. Video cutting open the gallbladder revealing hydrops (clear thick fluid).
3. Angry gallbladder.
4/5. Notice how thick the gallbladder wall is. It measured 8mm (normal is less than 2.5mm).
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#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . Acute cholecystitis occurs when a gallstone blocks the cystic duct and does not unblock on its own. This leads to congestion and inflammation, which is very painful. In this case, the gallbladder is so thickened and distended, it could not be gra

Kenichi T. Miyata, MD - General Surgeon
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Answers to my case presentation posted yesterday. Refer to that post for details of the case and try to answer the questions before reading below!
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1. What happened to cause these exam findings? At least one of the gallstones that was causing her biliary colic escaped the gallbladder and lodged at the Ampulla of Vater. This is at the distal end of the common bile duct, right before it enters the duodenum. It controls the flow of bile into the intestine but also is a narrowed area where a gallstone can get stuck. When a gallstone gets stuck, it can cause back up of the bile being made by the liver. Since the liver continuously makes bile, the bile duct will get distended (like blowing up a balloon). When it gets severe enough, the bile backs up and enters the blood stream, which deposits bilirubin into the eyes (scleral icterus) and then the skin (jaundice).
2. At what level of total bilirubin does the skin start to turn yellow? 2.5mg/dL.
3. Which of the two exam findings show up first? Scleral icterus.
4. What is the proper management of this problem? This problem is called obstructive jaundice from choledocholithiasis (common bile duct stone). The proper management is to have a GI doctor perform an ERCP (endoscopic retrograde cholangio-pancreatography) first. This is like a reverse colonoscopy. A camera is inserted into the mouth and advanced down to the second portion of the duodenum. The Ampulla of Vater is found, and a wire is snaked through the Ampulla and into the common bile duct. An x-ray is performed to look for any filling defects (the common bile duct stone). Once the CBD stone is confirmed, the Ampulla is slightly cut. A balloon is inflated from within the wire that was placed into the CBD, and the balloon is “swept” back into the intestine, which will sweep out the CBD stone and relieve the obstruction. The patient will then get their cholecystectomy before discharge from the hospital to prevent another gallstone escaping and getting stuck again.
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Image 1:  Mayo Foundation.
Images 2/3:  www.surgicalcore.org.
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#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . Answers to my case presentation posted yesterday. Refer to that post for details of the case and try to answer the questions before reading below! . . . 1. What happened to cause these exam findings? At least one of the gallstones that was causin

Kenichi T. Miyata, MD - General Surgeon
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This patient went to the ER with severe right upper quadrant abdominal pain. An ultrasound showed gallstones but no evidence of acute cholecystitis. Her labs were normal so she was sent home with pain medications. She was scheduled for elective cholecystectomy. She came to her pre-op appointment and it was noticed that her eyes were yellow as well as her skin.
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1. What happened to cause these exam findings?
2. At what level of total bilirubin does the skin start to turn yellow?
3. Which of the two exam findings show up first?
4. What is the proper management of this problem?
Comment your answers!!!
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#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . This patient went to the ER with severe right upper quadrant abdominal pain. An ultrasound showed gallstones but no evidence of acute cholecystitis. Her labs were normal so she was sent home with pain medications. She was scheduled for elective c

Kenichi T. Miyata, MD - General Surgeon
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Are you ridiculously good looking? Are you a surgeon? Are you a celebrity? Have you been on a major tv show like The Proposal? Are you a ridiculously good looking celebrity surgeon who won a major tv show like The Proposal? Of course you aren’t. Neither am I but my buddy @drbuckparker is! Follow his page for cool insight and surgery stuff!
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#theproposal #surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . Are you ridiculously good looking? Are you a surgeon? Are you a celebrity? Have you been on a major tv show like The Proposal? Are you a ridiculously good looking celebrity surgeon who won a major tv show like The Proposal? Of course you aren’t.

Kenichi T. Miyata, MD - General Surgeon
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Demonstration of a direct inguinal hernia. For orientation purposes, the head of the patient would be to the left of the screen.
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1. The forceps are grasping the direct inguinal hernia sac and it’s contents. I am reducing the hernia sac back into the abdominal cavity through the defect in the inguinal floor. The rubber tubing is a Penrose drain and is retracting the spermatic cord structures away. 
2. Hernia sac and contents.
3. The hernia is shown as a defect or hole in the inguinal floor.
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#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. Demonstration of a direct inguinal hernia. For orientation purposes, the head of the patient would be to the left of the screen. . 1. The forceps are grasping the direct inguinal hernia sac and it’s contents. I am reducing the hernia sac back into

Kenichi T. Miyata, MD - General Surgeon
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@justageneralsurgeon.
Gallstones come in many different shapes, sizes, and quantities. They can be made up of a variety of different combinations and percentages of cholesterol, bile salts, lecithin, bilirubin, etc. It is not clear what determines the type of gallstone a person will form. Yellow snd soft gallstones have more cholesterol in them, black ones have more bilirubin, and hard ones likely have more bile salt component to them.
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Comment on which type you like the most and let’s see which gallstone type is the most popular!!! Numbers 1-10!
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#surgeon #surgeon #nurse #nurses #doctor #doctors #hernia #physician #medstudent #medical #medicalstudent #medschool
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. . @justageneralsurgeon. Gallstones come in many different shapes, sizes, and quantities. They can be made up of a variety of different combinations and percentages of cholesterol, bile salts, lecithin, bilirubin, etc. It is not clear what determine

Kenichi T. Miyata, MD - General Surgeon
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Christmas classic!!!
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#wham #christmas #song #music #holiday
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. . Christmas classic!!! . #wham #christmas #song #music #holiday

Kenichi T. Miyata, MD - General Surgeon