Dr. Víctor Hugo Asquel - Cirugía General y Laparoscópica

01/02/2026

01/02/2026

🩺 SURGERY TRIADS

🔹 Charcot’s Triad

(Ascending cholangitis – biliary tract infection)

Components

→ Fever
→ Right upper quadrant abdominal pain
→ Jaundice

Pathophysiology

Obstruction of the common bile duct (usually gallstones) → bacterial infection → biliary sepsis.

Clinical pearls

• Most commonly caused by choledocholithiasis
• Common organisms: E. coli, Klebsiella, Enterococcus
• Medical emergency

⭐ If hypotension + altered mental status are added → Reynolds pentad (severe septic cholangitis)

🔹 Virchow’s Triad

(Mechanism of thrombosis)

Components

→ Stasis of blood flow
→ Endothelial injury
→ Hypercoagulability

Explanation

Any one—or combination—predisposes to venous or arterial thrombosis.

Examples

• Stasis: prolonged immobilization, heart failure
• Endothelial injury: trauma, surgery, smoking
• Hypercoagulability: malignancy, pregnancy, thrombophilia

⭐ Foundation for understanding DVT and pulmonary embolism.

🔹 Beck’s Triad

(Acute cardiac tamponade)

Components

→ Hypotension
→ Jugular venous distension
→ Muffled heart sounds

Pathophysiology

Rapid accumulation of pericardial fluid compresses the heart → reduced cardiac output.

Clinical pearls

• Causes: trauma, malignancy, uremia, post-MI
• Pulsus paradoxus often present
• Requires urgent pericardiocentesis

🔹 Saint’s Triad

(Classical association – not causal)

Components

→ Gallstones
→ Hiatus hernia
→ Diverticulosis of colon

Note

This is a historical association seen in elderly patients.
No proven pathophysiological link.

⭐ Important for exams but clinically coincidental.

🔹 Cushing’s Triad

(Raised intracranial pressure)

Components

→ Hypertension (widened pulse pressure)
→ Bradycardia
→ Irregular respirations

Pathophysiology

Raised ICP → brainstem compression → autonomic response.

Seen in

• Head injury
• Intracranial hemorrhage
• Brain tumors
• Hydrocephalus

⭐ Indicates impending brain herniation — neurosurgical emergency.

🔹 Portal Hypertension Triad
Components

→ Ascites
→ Splenomegaly
→ Varices (especially esophageal)

Pathophysiology

Increased portal venous pressure (commonly due to liver cirrhosis) → collateral circulation + fluid accumulation.

Clinical pearls

• Varices can cause life-threatening GI bleeding
• Splenomegaly leads to thrombocytopenia
• Ascites from sodium/water retention + portal pressure

01/02/2026

30/01/2026

30/01/2026

29/01/2026

In older patients with frailty and , ≥2 weeks of supervised, home-based multimodal reduced postoperative complications and enhanced functional capacity vs ERAS alone. https://ja.ma/3M31kDc

28/01/2026

🚨 Hoy fue una hernia… mañana pudo ser una tragedia.

Un paciente de 62 años llegó de emergencia con una hernia inguinal estrangulada.
El intestino estaba atrapado, sin circulación sanguínea.
Cada minuto contaba.

❗ Lo más duro: esta hernia llevaba años sin tratarse.

Muchas personas piensan:
👉 “No duele, no es grave”
👉 “Después me opero”
👉 “Puedo esperar”

Pero la realidad es otra:
⚠️ Una hernia no tratada puede convertirse en una emergencia quirúrgica que pone en riesgo la vida.

✅ Operarse a tiempo no es un lujo, es prevención.
✅ Operarse a tiempo es seguridad.
✅ Operarse a tiempo es salvar órganos… y vidas.

👨‍⚕️ Si tienes una hernia, no esperes a que sea demasiado tarde.
La cirugía programada siempre es más segura que la cirugía de emergencia.

📍 Tu salud no espera.
👨🏻‍⚕️ Dr Víctor Hugo Asquel Cadena
Cirugía General y Laparoscopía
☎️ Teléfono 0992677144

28/01/2026

Indicaciones de CPRE

ACG-ASGE Quality Indicators for ERCP
Anderson, et al.

📕 doi.org/10.14309/ajg.0000000000003825

26/01/2026

Hemorrhoidal disease (often called “hemorrhoids”) involves abnormalities in the tissues lining the a**l ca**l. Hemorrhoids affect approximately 10 million people in the US and can have negative effects on quality of life.

📄 This JAMA Patient Page describes hemorrhoids and their symptoms, diagnosis, and treatment.

https://ja.ma/4sQuTZk

22/01/2026

Elevated preoperative HbA1c was associated with increased risks of complications, readmissions, and mortality in general surgery patients, supporting routine HbA1c screening for all surgical candidates, regardless of history. https://ja.ma/45ULNfp

22/01/2026

💬 Editorial: Among adults with acute uncomplicated , findings from the APPAC trial indicate that antibiotic therapy remains a safe and feasible alternative to .

At 10 years, 44% of patients who initially received antibiotics ultimately required appendectomy, with reduced cumulative complication rates compared to surgery.

Quality of life and patient satisfaction were similar between treatments. Ultimately the decision should be an individual one between patients and clinicians.

https://ja.ma/4bGI9cL