Wednesday afternoon, I got to assist with my first thyroidectomy, where we remove the entire thyroid gland from the neck. These procedures are dreaded by most med students because they take forever, usually about 4-5 hours. Often, four people are all crowding around a small, deep incision in the patient's neck, which means lots of retracting at awkward angles and in awkward stances. The work is all very meticulous because the structures of the neck are all so close together. If you're not careful, you might cut a nerve (causing voice hoarseness), perforate the trachea, pierce the jugular veins or carotid arteries, or remove one or more tiny parathyroid gland along with the thyroid.
YesterdayIL: Giant paraesophageal hernias are called "giant" because the term groups together the two largest classifications of hiatal hernias (III and IV).
Paraesophageal hiatal hernias are when the stomach/esophagus junction stays in place (unlike in the more common
sliding hiatal hernia), but another portion of the stomach actually squeezes through the gap into the chest cavity.
Giant paraesophageal hernias are actually quite dangerous because they are usually relatively asymptomatic unless the stomach gets completely pinched off, forming what's called a gastric volvulus. This is a surgical emergency and has a very high mortality rate without prompt treatment (>50%).
When surgically repairing the hernia, if the stomach appears viable, you must secure it in the abdominal cavity. To do this, you need to attach, either with sutures or gastric tubes, in at least two locations to prevent the stomach from twisting around a single point of attachment and becoming ischemic (not getting blood/nutrients).
TIL: When doing a post-operative check on a thyroidectomy patient, ask the person to mimic you at various vocal tasks like a singer (e.g. "Repeat after me, 'La la la!' 'Sol sol sol!' 'Mi mi mi!'")
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