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🗂محتويات الملف 👇🏻
1✨Hernia.
2✨General examination.
3✨Hernia.
4✨a (تجارب).

د.#عبده_شمسان
#ملخصات_جراحة
#جراحة_عملي
@Arm_Plus36

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🔹ملخصات نظري للدكتور عبده شمسان 👇🏻

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🗂محتويات الملف 👇🏻
1✨Morse fall Scale.
2✨How to assess the state of consciousness. (هام‼️)
3✨DVT risk score interpretation. (هام‼️)
4✨Pain scale.
5✨Glasgow coma scale.
6✨Notes in Hx taking & clinical Ex (‼️مهم جدااااااً‼️).
7✨a (ملخصات إضافيه).

د.#علي_محمد_صالح
#ملخصات_جراحة
#جراحة_عملي
@Arm_Plus36

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🗂محتويات الملف 👇🏻
1✨Burns🔥
2✨Hernia.
3✨Intestinal obstruction & Ulcers.

د.#نصر_القدسي
#ملخصات_جراحة
#جراحة_عملي
@Arm_Plus36

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🗂 ملخص للدكتور #زيد_شيبان👇🏻

#ملخصات_جراحة
#جراحة_عملي
@Arm_Plus36

الأربعاء :
10-11-2021

الأسبوع الأول :
محاضرة الدكتور / زيد شيبان


⭐Part 1

▪️Psoas sign : right hip flextion for relief of pain of appendicitis , because an inflamed appendix lies on the psoas muscle.

▪️ pain of pancreatitis is relieved by leaning forwards.

▪️in case of pleural effusion in one side, the pt prefers to sleep on that side, so the other lung can fully expand during breathing .

💡the decubitus and gate of pt is very important as they change with many illnesses so you can search and read about them .


🔹as the pt lost consciousnesses
you must check his state of hydration , nutrition :

* dehydration :
loss of total body water.
( lose of interacelluar water leads to hypertoncity )
there is loss of water more than Na loss.


* volume depletion : loss of extracelluar volume only ( proportionate loss of water and Na)
as in vomiting , diarrhoea , polyuria,)

▫️ dehydrated pt is assessed by : sunken eyes, dryness of tongue , loss of skin elasticity , low urine output , absence of axillary sweating .

▫️assessment of subcutaneous fat :
over triceps, subscapular , thighs, buttocks .

▪️assessment of muscle mass:
tricpes, biceps, muscles of legs ..


▪️BMI =
less than 16 —› severe malnourished
more than 25 —› overweight
more than 30 —› obese



🔹Tilt test :

read about pathophysiology ( important )

the pt is kept in a spuine position for 2 mins then he stands up then his B.P and heart rate are measured to evaluate the cause of repeated unexplained episodes of lightheadedness, dizziness or fainting. The test can help determine if the cause is related to your heart rate or blood pressure.

◼️ capillary refill time :
normal if refilling is within 3 seconds .
it's prolonged in pt with hypovolumic shock .

*cardiogenic shock :
persistent drop of cardiac output despite normal blood volume.


🔶 Vascular diseases :
in atherosclerosis : the fat deposition is subintimal and my extend to the muscular layer.


🔹in peripheral vascular diseases if it's :

*chronic : look for trophic changes like atrophic skin, loss of hair , color changes and ulcers.

*acute ( which may be caused by embolism , thrombosis , or trauma.)
: look for the six Ps :
painful, pluseless, pale, paralysis , perishing cold, paraesthesia.


* intermittent claudication: exertional pain of calf muscles

▪️you must assess the functional capacity of pt :
how far he used to walk?
and how illness restricted his activities? ans does pain comes at rest or with exertion .

in low functional capacity you will notice the pt changes his posture to use muscles unaffected by the vascular disease.


◼️collaterals take time to develop so they're found in chronic vascular diseases but not in acute state.

▫️when there are collaterals › good prognosis.


◼️saphenous vein is rich site for collaterals while popliteal vein is poor site .

🔹 internal mammary aa are better for coronary bypass surgery than saphenous veins ( there is intimal hyperplasia of saphenous vein )


🔹statins are the best antilipid drugs as they can regress the size of atherosclerosis.


▫️Arteriosclerosis : arterial wall thickening and loss of elasticity.
Aneurysm : dilation of blood vessels or heart.
it involves all the 3 layers of artery. especially the media where there is loss of elasticity of internal & external lamina .

complications of aneurysm :
obstruction , embolism , rupture , compression of adjacent structures « symptoms of mediastainal compression like dysphagia, dyspnea, cough, hoarseness of voice »


◼️ aortic dissection : A tear in the intima leads to blood surging into the aortic media separating the intima and adventitia.
the pattern of pain of acute dissection : sudden onset of stabbing or tearing ( very severe, worse than that of MI) pain in ant. chest radiated to the back between scapulae .

there is also loss of consciousnesses and multiorgan failure .( so do a review for all systems )




🔹 a valvular disease that can cause mediastinal compression is Mitral stenosis ( left atrial enlargement )
consequences of Lt. atrial enlargement :

⭐Part 2

*Atrial fibrillation ( most serious as complicated by mural thrombosis & emboli) .
*pulmonary HTN ( backward consequence )

*cardiogenic shock ( forward consequence )

note : always consider preload, afterload , & contractlity when dealing with heart diseases .
never do surgery for old age pt with pulmonary HTN especially females .
if necessary ,anticogulate the pt untill ACT « activated clotting time » becomes 400 or more « normally it's up to 180 » .

antidote of heparin is protamine.
which may cause anaphylactic reactions in some female pt.

◼️ if a heumatic heart disease pt come to ER with AF
first chech if AF is with :
1- high ventriclar rate ( serious )
2- low ventriclar rate

look for the ECG & BP :
if there is drop of BP, so the pt needs DC shock.

also ask about the duration of AF
if it's 72 hrs or more : anticogulate the pt .

( it's estimated that it takes 72hrs ,since onset of AF, to develop thrombosis )

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يتبع ملخص الدكتور محمد الشهاري 👇🏻
✨Intestinal obstruction
✨Swelling

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