How to differentiatebetween submandibular gland stones and submandibular LN Enlargement?

-History of pain and swelling that increase after eating
-Swelling is solitary and can't be rolled over the mandible. مايقدرش يتحرك فوق.
-Inspection of the mouth floor may reveal redness of duct orifice.
-Bimanual palpation reveals swelling is filling the floor of the mouth.

#Surgery

In submandibular gland stones:

Plain x-ray (closed mouth view):
-Stone in the submandibular gland is radio-opaque in 8o ٪ of cases.

Sialogram:
-Shows the radiolucent stones.


بعكس الـ Parotid stones اللي هن أصلاً rare، وكذا يكونين Radiolucent.

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Cullen's sign:

-Periumbilical eccymoses seen in Retroperitoneal hemorrhage mostly with Acute pancreatitis.

Grey turner's sign :
-Seen with retroperitoneal hemorrhage , ecchymosis or dislocation of flank as result of dissecting blood from retroperitoneum as in AP.

Kehr's sign:
-Seen with splenic rupture, it is severe left shoulder pain (referred pain from diaphragmatic irritation).


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Virchow's node:
Metastatic tumor to left supraclavicular node (usually due to gastric cancer).

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-Painless progressive jaundice in elderly , consider as Pancreatic carcinoma until proven otherwise.

-Patient coming with acute onset aphasia , consider as Stroke until proven otherwise.

-Unilateral lower limb swelling consider as DVT until proven otherwise.

-Appearance of Iron deficiency in an adult male means GIT blood loss until proven otherwise.

-Painless hematuria in elder person consider as Bladder carcinoma until proven otherwise.

#Medicine

Urgent surgery is the surgery, which should be done early (within12–36hours).

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What is the classic position of a patient with peritonitis?

-Motionless (often with knees flexed).


What is the classic position of a patient with a kidney stone?

-Cannot stay still, restless, writhing in pain.

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What is a “left shift” on CBC differential?

-Sign of inflammatory response:
Immature neutrophils (bands)

-Note:
Many call 80% of WBCs as neutrophils a “left shift”.

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What is gastroenteritis?

-Viral or bacterial infection of the GI tract, usually with vomiting and diarrhea, pain (usually after vomiting), nonsurgical.

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What is the most common cause of RUQ pain?
-Cholelithiasis.

What is the most common cause of surgical RLQ pain?
-Diverticulitis.

What is the most common cause of GI tract LLQ pain?
-Acute appendicitis.

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•What is more dangerous: a small or large hernia defect?

-Small defect is more dangerous because a tight defect is more likely to strangulate if incarcerated.

•Incarcerated means:
Swollen or fixed within the hernia sac (incarcerated imprisoned); may cause intestinal obstruction (i.e., an irreducible hernia).

•Incisional hernia:
-Hernia through an incisional site; most common cause is a wound infection.

•Epigastric hernia:
-Hernia through the linea alba above the umbilicus.

•Cooper’s hernia:
-Hernia through the femoral canal and tracking into the scrotum or labia majus.

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•What are the layers of the abdominal wall?

Skin
Subcutaneous fat
Scarpa’s fascia
External oblique Internal oblique Transversus abdominus
Transversalis fascia
Preperitoneal fat
Peritoneum

•Note:
-All three muscle layer aponeuroses form the anterior rectus sheath, with the posterior rectus sheath being deficient below the arcuate line.

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What is the conjoint tendon?

-Aponeurotic attachments of the “conjoining” of the internal oblique and transversus abdominis to the pubic tubercle.

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US Criteria of Acute cholecystitis:

-GB stone
-Biliary sludge "turbid bile"
-Thickened wall
-Strip of fluid" pericholecystitis"

#Surgery

Synthetic mesh.

Criteria of an ideal mesh.
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VENTRAL HERNIA:

-Any protrusion through abdominal wall with the exception of hernia through the inguinofemoral region is defined as ventral hernia.
-Incisional hernia (80%) and primary defects in abdominal fascia which can cause umbilical hernia, epigastric hernia, paraumbilical hernia or Spigelian hernia are grouped under ventral hernia.

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RECURRENT HERNIA (Inguinal)

-Incidence is 10%.
-If recurrence is within 3 years it is called as early.
-If it is after 3 years it is late.

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NON-UNION:

-Fracture not united at end of 9 months and there is no progress in fracture healing in last 3 months is Non-union.

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Delayed Union:
-If no healing by > 3 months but less than 6 months.

Non-Union:
-If no healing by > 6 months.

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How to know if the chest tube is functioning or not?

-Swinging movement of fluid in the tube, if not ask the patient to cough.
-Air bubbles.

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