Among the sources of bleeding, fractures are not to be taken lightly,

-For each rib fracture, blood loss can range from 100-200 mL,
-Tibial fractures can yield 300-500 mL,
-Femoral fractures can produce 800-1000 mL,
-Pelvic fractures may cause loss of more than 2000 mL.

#Surgery

Bed sore score:

Grade 1: redness erythema not disappear with pressure.
Grade 2: superficial ulcer
Grade 3: superficial and subcutaneous tissue but not through fascia.
Grade 4: deep to muscles and joints.

#Surgery

Exceptions of Courvoisier's law (in 20% of cases):

a-Calcular obstruction of CBD with palpable G.B. :
1.Metabolic stone with a healthy distensible G.B.
2.Stone in CBD & another stone in cystic duct .
3.A stone of Hartmann's pouch obstructing both cystic duct and CBD (Mirrizi syndrome).

b-Malignant obstruction of CBD without G.B. enlargement:
1.Associated chronic cholecystitis.
2.Malignancy at the porta hepatis.

#Surgery

- Most Common organ injured in blunt abdominal trauma is the spleen ( the second is the liver).

-Most Common organ injured in penetrating abdominal trauma is the small intestine.

-Blunt truma patient with hemodynamic instability should be evaluated by USG ( FAST).

-FAST =( Focused  assessment  with  Sonography for Trauma)
                           👇🏽
-Rapid diagnostic examination to assess patients with potential thoracoabdominal injuries , performed  within 2 - 4 minutes

#Surgery

•Redness more dangerous than cynosis in ischaemic limb, Why?

-Because redness means extravasation of blood form dead. tissues.

#Surgery

-Crystalloids include saline, Ringer’s lactate, and glucose.

-Colloids include blood products such as red blood cells (RBCs) and albumin.

#Surgery

ERCP Complications:

2B 2P
2B
1-Bleeding
2-Bacterial cholangitis.

2P
1-Perforation 
2-Pancreatitis.

#Surgery

Features of compartment syndrome:
The 6 Ps

-Pain
-Pallor
-Paresthesias
-Pulse deficit
-Poikilothermia
-Paralysis.

#Surgery

Rule in RTA:

-Any unconscious patient should be considered as having spinal cord injury untill proved otherwise.

#Surgery

Meckel’s diverticulum (Rule of 2’s):

•2% of population
•2 times commoner in males
•2 feet proximal to ileocaecal valve
•2 inches in length
•2 types of common ectopic tissue
(gastric and pancreatic).

#Surgery

Rule in malignant surgery:

-Don not do surgical operation for cancer if metastasis is present.

-Note: may be done if the operation is for palliative procedure in critical sites as trachea .

#Surgery

Remember 6F

•Follicular carcinoma of Thyroid:
-Follicular
-Female
-Forty
-Far away "mets. by blood"
-FNAC" not conclusive "
-Familial.

•Gall stones:
-Forty
-Female
-Fatty
-Fair
-Flatulent
-Fertile.

•Generalized abdominal distention:
-Fluid
-Fetus
-Full bladder
-Faces
-Fat
-Fibroma
-Flatus.

#Surgery

GALLSTONE ILEUS

-It is a type of acute intestinal obstruction, often seen in elderly and is due to blockage by a bolus or mass of gallstones which commonly enter the intestine through cholecystoduodenal fistula (75%) or rarely through cholecystointestinal or gastric fistulas.


#Surgery

Aortoiliac disease (Leriche syndrome)

-Triad of bilateral buttock, hip, or thigh claudication, erectile dysfunction, and absent/diminished femoral pulses.

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•Thyroid swelling and toxic features appear simultaneously in primary thyrotoxicosis.

#Surgery

-Dyspnea in thyroid:
• Tracheomalacia in long standing MNG
• Retrosternal extension
• Cardiac failure due to secondary thyrotoxicosis
•Infiltration by anaplastic carcinoma.

-Hoarseness of voice:
•Infiltration of recurrent laryngeal nerve by malignancy
• Edema of vocal cord.

#Surgery

Goiter is usually painless.

Pain is seen in cases of:
–Hemorrhage
–Malignancy infiltrating the nerves
–Thyroiditis
–Anaplastic carcinoma.

#Surgery

•In secondary thyrotoxicosis cardiac manifest is more common than eye manifest. Why?

-Because secondary thyrotoxicosis is already common in old age with aged heart and complications ,so the sympathetic over activity affects the heart more.
-Primary thyrotoxicosis is common in young age.

What is the dose of thyroxine given?

Thyroxine doses: (T4) Eltroxin(Levothyroxine) tablet: 0.1 mg tablet available.

1-Supplement treatment (hypothyroidism): 👉🏼1 tablet (0.1mg).

2-Substitution treatment (after thyroidectomy): 👉🏼2 tablets (0.2mg).

3-Suppression treatment (for papillary carcinoma): 👉🏼3 tablets(0.3mg).

#Surgery

-FNAC cannot differentiate follicular adenoma and carcinoma ,because the differentiation is based on capsular invasion.

#Surgery