Ep-PAINE-nym



Morison’s Pouch

Other known aliaseshepatorenal recess/fossa, right posterior subhepatic space

Definitiona potential space between the liver and the right kidney

Clinical SignificanceThis a space where fluid can accumulate in the setting of ascites or abdominal trauma and be seen on CT or ultrasound.  It is one of the view of a Focused Assessment of Sonography in Trauma (FAST) exam. Typically, 30-40mL of fluid needs to be present to be visualized.

Ultrasound
Computed Tomography

HistoryNamed after James Rutherford Morison (1853-1939), a British surgeon who received his medical degree from the University of Edinburgh in 1874.  He was also an assistant and “surgical dresser” for Joseph Lister early in his career and later founded a school of surgery at the University of Durham where he made his name as a prolific instructor of surgery.  He is well known as a pioneer of modern surgery with several of his contemporaries noting he was twenty years ahead of his time and was a driving force of he surgical arts in Great Britain at the turn of the 20th century. 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. http://livesonline.rcseng.ac.uk/biogs/E004690b.htm

Ep-PAINE-nym



Zenker’s Diverticulum

Other Known Aliasespharyngeal diverticulum

Definitionsac-like outpouching of the mucosa and submucosa through Killian’s triangle, which is the area of structural weakness between the cricopharyngeus and lower inferior constrictor muscles.

Clinical SignificanceThere are actually three different types of diverticulae that can form in this region and are based on anatomic location:

  • Zenker’s – immediately above the upper esophageal sphincter
  • Traction – near midpoint of the esophagus
  • Epiphrenic – immediately above the lower esophageal sphincter

Signs and symptoms of a Zenker’s diverticulum are pretty awful and include dysphagia, pulmonary aspiration, and halitosis from partially rotting food in the outpoaching.  It is diagnosed via barium swallow under flouroscopy. The majority of the patients are male and present after the age of 60.  Management is surgical resection.

HistoryNamed after Friedrich Albert von Zenker (1825-1898), who was German physician and pathologist and received his medical doctorate at Leipzig in 1851.    He held numerous teaching posts including chief prosector and professor of general pathology and anatomy at Dresden city hospital.  Dr. Zenker, along with Hugo Wilhelm von Ziemssen, published a case series and literature review on his eponymous diverticulum in 1867 entitled “Krankheiten des Oesophagus”. He also was the first to document and describe trichinosis in a girl who died in 1860, proving that the once thought harmless parasite could cause severe disease.

Friedrich Albert von Zenker

References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. F. A. Zenker and Hugo Wilhelm von Ziemssen:
    Krankheiten des Oesophagus. Leipzig, 1867
  7. Ueber die Trichinenkrankheit des Menschen. Virchows Archiv für pathologische Anatomie und Physiologie und für klinische Medizin, Berlin, 1860, 18: 561-572.

Ep-PAINE-nym



Hesselbach’s Triangle

 

Other Known Aliases – Inguinal triangle, medial inguinal fossa

DefinitionAnatomical region of the abdominal wall outlined by the boundaries of the lateral margin of the rectus sheath, the inferior epigastric vessels, and the inguinal ligament.

Inguinal triangle.png

Clinical Significance – The area is where direct hernias protrude through the abdominal wall.

Image result for direct hernia

History – Named after Franz Kasper Hesselbach (1759-1816), who was a German physician, surgeon, and anatomist in Hammelburg, Germany.  He had a prolific career surgical assistant and prosector under Karl Kasper von Siebold at The Juliusspital in Würberg, before obtaining his doctor of medicine there.  He is best known for his contributions to the surgery of hernias and has several other eponyms as well: Hesselbach’s fascia (cribriform fascia) and Hesselbach’s ligament (interfoveolar ligament.

Image result for franz kaspar hesselbach

From his 1806 manuscript


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Tubbs RS, Gribben WB, Loukas M, Shoja MM, Tubbs KO, Oakes WJ. Franz Kaspar Hesselbach (1759–1816): anatomist and surgeon. World journal of surgery. 2008; 32(11):2527-9. [pubmed]
  6. Hesselbach HK. Anatomisch-chirurgische Abhandlung über den Urspurng der Leistenbrüche. Würzburg, Baumgärtner. 1806.
  7. Hesselbach HK. Neueste anatomisch-pathologische Untersuchungen über den Ursprung und das Fortschreiten der Keisten- und Schenkelbrüche. Würzburg, Stahel. 1814

PAINE #PANCE Pearl – Gastrointestinal



Question

 

What are the some of the pancreatitis scoring systems that are commonly used to estimate severity and mortality?



Answer

 

There are several scoring systems for estimating severity and mortality in pancreatitis.

 

  1. Ranson’s Criteria
    1. This is probably the most well known and estimates severity on admission and mortality after 48 hours:
      1. On Admission
        1. Glucose > 200 mg/dL
        2. AST > 250
        3. LDH > 350
        4. Age > 55
        5. WBC > 16,000
        6. ≥ 3 suggests severe pancreatitis and ICU admission
      2. After 48 hours
        1. > 10% decrease in hematocrit
        2. > 5 mg/dL increase in BUN
        3. < 8 mg/dL in serum calcium
        4. < 60 mmHg in PaO2
        5. > 4 base deficit
        6. > 6L fluids needed
        7. Predicted Mortality
          1. 0-2 – 1%
          2. 3-4 – 15%
          3. 5 – 40%
  2. Bedside Index of Severity in Acute Pancreatitis (BISAP)
    1. Predicts mortality
      1. BUN > 25 mg/dL
      2. GCS < 15
      3. Evidence of SIRS (2 of the following)
        1. Temp < 36oC or > 38oC
        2. Respiration > 20 or PaCO2 < 32 mmHg
        3. Heart rate > 90 bpm
        4. WBC < 4000, > 16,000, or > 10% bands
      4. Age > 60
      5. Imaging reveals pleural effusions
    2. Predicted Mortality
      1. 0-2 – < 2%
      2. 3-5 – > 15%
  3. CT Severity Index (CTSI)
    1. Assesses severity of pancreatitis via contrast enhanced CT and is the the sum of two scores:
      1. Balthazar Score
        1. 0 – normal pancrease
        2. 1 – enlargement of pancrease
        3. 2 – inflammatory changes in pancrease and peripancreatic fat
        4. 3 – defined single peripancreatic fluid collection
        5. 4 – two or more poorly defined peripancreatic fluid collections
      2. Pancreatic Necrosis
        1. 0 – none
        2. 2 – < 30%
        3. 4 – 30-50%
        4. 6 – ≥ 50%
      3. Assessment
        1. 0-3 – mild
        2. 4-6 – moderate
        3. 7-10 – severe
  4. Glasgow-Imrie Criteria for Severity of Acute Pancreatitis
    1. This one has a nice mneumonic (PANCREAS):
      1. PaO2 < 60
      2. Age < 55
      3. Neutrophil (WBC) > 15,000
      4. Calcium < 8 mg/dL
      5. Raised BUN > 45 mg/dL
      6. Enzyme (LDH) > 600 IU/L
      7. Albumin < 3.2 g/dL
      8. Sugar (glucose) > 180 mg/dL
    2. ≥ 3 points suggests severe disease

 


References

  1. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surgery, gynecology & obstetrics. 1974; 139(1):69-81. [pubmed]
  2. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008; 57(12):1698-703. [pubmed]
  3. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990; 174(2):331-6. [pubmed]
  4. Knipe H, Cuete D.  CT Severity Index in Acute pancreatitis.  Radiopaedia.
  5. Blamey SL, Imrie CW, O’Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut. 1984; 25(12):1340-6. [pubmed]

Ep-PAINE-nym



Murphy’s Sign

 

Other Known AliasesMoynihan’s Method (using just the thumb with patient supine)

DefinitionInspiratory arrest with deep palpation in the right upper quadrant 

Clinical SignificanceAs the patient exhales, the abdominal organs move cephalad and under the diaphragm.  After full exhalation and during inspration, the organs move caudal back into the abdominal cavity.  When there is inflammation of the gallbladder, the patient will stop inhaling as the inflammed gallbladder touches the practitioner’s fingers during deep palpation of the right upper quadrant.

History – Named after John Benjamin Murphy (1857-1916), who was an American surgeon and early pioneer for many different surgical operations and techniques.  In fact, William James Mayo (co-founder of The Mayo Clinic) called him “the surgical genius of our generation”. 

In 1889, he advocated for and popularized early appendectomy in all suspected appendicitis cases and had over 200 successful cases to begin convincing his colleagues of the benefits of early surgery.  Dr. Murphy also pioneered treatment of tuberculosis with iatrogenic pneumothoraces and was the first surgeon to re-anastomose a transected femoral artery from a gunshot wound.  He was also a distinguished teacher and developed “wet clinics” at Mercy Hospital, where he operated and lectured to an audience of learners in a traditional operative theater.

https://upload.wikimedia.org/wikipedia/commons/7/7e/John_B._Murphy_clinic.jpg

Dr. Murphy also attended to Theodore Roosevelt after an assassination attempt and was one of the founding members of the American College of Surgeons.  He is also the author of one of the more famous quotes pertaining to patient-centered care.


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com