Pancreatic surgeries are indicated in the management of malignant/symptomatic benign tumors pancreas. The choice of surgery depends on the location, size, and extent of the malignancy/injury. Depending on the extent of resection, pancreatic surgeries for malignancy include enucleation (for islet cell tumors), partial pancreatic resections (distal pancreatectomy, central pancreatectomy, pancreaticoduodenectomy/Whipple procedure), and total pancreatectomy. Chronic pancreatitis patients with a dilated main pancreatic duct (> 5 mm), not responding to conservative therapy, are candidates for lateral pancreaticojejunostomy with/without resection of the pancreatic head. Complications of pancreatic surgeries include anastomotic leaks, pancreatic ascites/fistula, and exocrine/endocrine insufficiency.

Hepatic surgeries are indicated in the management of malignant/symptomatic benign tumors and traumatic lacerations of the liver .The choice of surgery depends on the location, size, and extent of the malignancy/injury. Depending on which segments of the liver are removed, hepatic resections include right/left hepatectomy, right/left lobectomy, and segmentectomy. Wedge resections of the liver are performed for small, peripherally located lesions. Complications of hepatic resections include liver failure, hemorrhage, hemobilia, and bile leaks.

Abdominal compartment syndrome (ACS) is caused by increased pressure in the abdominal cavity (i.e., intraabdominal hypertension) and is most commonly seen in critically ill or injured patients. ACS can be caused by reduced abdominal wall compliance, visceral edema, increased luminal contents, or increased abdominal contents and manifests with organ dysfunction, including acute kidney failure, respiratory failure, and shock. Diagnosis is made with urinary bladder pressure measurement, which provides an indirect measure of intraabdominal pressure. Initial conservative measures are aimed at improving abdominal wall compliance, reducing abdominal cavity volume, and optimizing fluid balance and organ perfusion. If these measures fail to lower intraabdominal pressure, urgent decompressive laparotomy is required, typically followed by temporary abdominal closure.

Transplantation is the process of transferring an organ or part of an organ (known as a graft) from one donor to either themselves (autologous transplantation) or another recipient (allogeneic transplantation) or their genetically identical recipient (isograft transplantation). In addition to being subject to strict legal requirements, the donor and recipient must be histocompatible in allogeneic transplantations to minimize the risk of transplant rejection. Because the major histocompatibility complex (MHC) is only perfectly matched in isotransplantation (involving the transfer of genetically identical tissue, e.g., between identical twins), allogeneic transplantation subsequently requires immunosuppressive therapy. Close follow-up and infection prevention measures (e.g., vaccination) are required because of the risks of posttransplant infection and graft rejection

Dissection of the carotid or vertebral arteries (collectively known as the cervical arteries) refers to the separation of the tunica media and tunica intima of a vessel. Cervical artery dissection can cause stenosis, thrombosis, or distal embolization. Most affected individuals are adults. Cervical artery dissections may occur after major trauma (e.g., motor vehicle crashes) or minor events (e.g., sneezing) and typically manifest with a headache, which may be followed by ischemic features (e.g., stroke) a few hours or days later. CT angiography (CTA) or MR angiography (MRA) of the head and neck is used to establish the diagnosis. Management is based on clinical presentation and includes antithrombotic agents for most patients, thrombolysis for patients with signs of ischemic stroke, and surgery in selected cases. Complications include recurrent stroke and/or dissection, delayed formation of a dissecting aneurysm, and complications associated with ischemic stroke.

Mild Traumatic Brain Injury (mTBI) is a trauma-induceddisruption of brain function on the lowest end of the TBI severityspectrum, typically due to a fall, Motor vehicle accidents, or sportsinjury. Characteristic manifestations include a GCS ≥ 13–15, transientLoss of consciousness, altered mental status at the time of injury,posttraumatic amnesia, and minor neurological abnormalities that do notrequire surgical intervention. Concussion, a term often used synonymouslywith mTBI, is difficult to define but typically refers to a heterogeneous subset of TBI with variable constellations of physical,cognitive, and neuropsychiatric features and variable recovery times. mTBI isprimarily a clinical diagnosis. Neuroimaging is notroutinely indicated, as it is frequently normal or reveals only minor findingsthat do not alter management. Clinical decision rules for neuroimaging shouldbe used to identify patients at risk of intracranial lesions that requiresurgical intervention. Most patients with a reassuring clinical presentationcan be treated as outpatients after a period of observation, while some benefitfrom hospital admission and monitoring. If at any point during the observationperiod the GCS deteriorates to < 13, the patient should bereclassified as moderate TBI or severe TBI and managedaccordingly. The mainstay of treatment of mTBI is physical andcognitive rest until patients are completely asymptomatic, followed by agradual return to activity. Most patients recover completely within 1–2weeks and better outcomes are associated with early diagnosis and Treatmentadherence. Post concussion Syndrome is the most common complication,causing symptoms lasting for weeks to months that usually require multidisciplinarycare and follow-up.

Links to Calculators ( Courtsey:Calculate by QxMD):

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Traumatic brain injury (TBI) is defined as a structural injury to the brain or a disruption in the normal functioning of the brain as a result of a blunt or Penetrating head injury. Head injury refers to trauma to the head that may or may not be associated with TBI, soft tissue injury, or skull fractures. Primary brain injury occurs as an immediate consequence of head injury at the time of the trauma.Secondary Brain Injury is indirect and results from physiological changes triggered by the initial impact and/or acute management measures; it is preventable to a certain degree. TBI is most frequently seen in young children, teenagers, and individuals older than 65 years, with falls and Motor vehicle collisons being the leading causes. The Glasgow Coma Scale is a commonly used scoring system used to assess the severity of TBI and guide management. Clinical Features of TBI depend on the severity, type, and location of brain injury. Impaired consciousness is common in severe TBI whereas patients with mild TBI may only present with transient confusion and headache.Neuroprotective measures to prevent or minimize secondary brain injury should be the main focus of initial management of all patients with TBI. Patients with moderate TBI or severe TBI should be transferred to a neurocritical care unit at the earliest. After initial resuscitation, a head CT without contrast should be obtained to identify the type and extent of injury. Definitive management varies depending on the type and severity of injury.

Intracranial epidural hematoma (EDH) refers to bleeding between the dura mater and the calvarium. Most cases of EDH are traumatic, resulting from a head injury with an associated skull fracture that ruptures or tears the middle meningeal artery, which lies in close proximity to the skull and dura mater. EDH is more common in individuals 20–30 years of age, as the dura mater is not yet densely adherent to the calvarium at this age. The classic manifestation of EDH is an initial loss of consciousness, followed by a lucid interval in which the patient gains normal or near-normal consciousness, followed by rapid neurological decline. An ipsilateral dilated pupil (anisocoria) and contralateral hemiparesis are manifestations of transtentorial uncal herniation and signal imminent neurological decline. Neuroprotective measures to prevent secondary brain injury take precedence over diagnostic tests. Diagnosis is confirmed on a noncontrast CT head, on which EDH appears as a biconvex, hyperdense lesion, typically in the temporal or temporoparietal region. Surgical decompression with craniotomy is indicated in patients with large EDH, GCS ≤ 8, and evidence of neurological deterioration. Small, asymptomatic EDH in patients with GCS > 8 can be managed conservatively with close observation and serial CT scanning. The prognosis depends on several factors, including the GCS at presentation, size of the EDH, and, crucially, the time from the onset of brain herniation to decompressive surgery. Early intervention in patients with signs of brain herniation is associated with good neurological outcomes and lower mortality rates.