Examination of an Incision 

By inspection:

Site, side, length, direction, the healing by primary or secondary intention,  relation to deep structures  any signs of complication of incision as hematoma, discharge, swelling, redness..etc

-If there's dressing, comment on:
Site, side, dry or wet, clear in colour or red, yellow...

-Do not forget to say to the examiner:
"I shoud to expose the dressing".


#Surgery

Difference between small and large bowels obstruction on X-ray.

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Types of wounds.

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-Gall stone may obstruct the ileum leading to what called- Gall stone ileus.
Or
-Leads to gastric outlet obstruction  is called- Bouverte's syndrome.

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•Difference between submandibular lymph node and submandibular gland swelling:

1. Nodes usually are multiple while gland single swelling
2. Node could be over rided the body of mandible while the gland is not
3. Gland could be palpated bimanually
(From the skin and from the floor of tongue )
4.gland swelling and pain may increase during induce sour food while node show no changes
5. As the most common cause of submandibular gland swelling is duct stone we may feel it by palpation.

#Surgery

Canula.

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-Beware After 4–6 hours, the acid in the peritoneal cavity becomes diluted and the pain and guarding decrease.
-Patients think they are improving, but they are in fact getting worse.
-The peritonitis is progressing and hypervolaemia is developing.
-An increasing tachycardia and absent bowel sounds associated with increasing abdominal distension and sunken eyes indicate that the patient is becoming extremely ill.

-Browse notes
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-Para umbilical hernia is any hernia within 3cm around umbilicus so any hernia beyond 3cm away from umbilicus is not termed para umbilical hernia.


-Epigastric hernia is misdiagnosed as heartburn because in early cases of epigastric hernia, the main complaint is epigastric pain and not mass.


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•The most complications of GIT problems are:

-Hemorrhage
-Bleeding
-Stricture.

•And the first line in treatment of these complications is insertion of Ryle's tube.

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Gustilo classification .

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What is a Petersen's hernia?

-Internal hernia is a rare late complication of laparoscopic Roux-en-Y gastric bypass surgery.

-Petersen's hernia occurs most commonly seen after laparoscopic gastric bypass surgery .

د.فواز.
#Surgery

All abdominal pains are acute pain except in 5 conditions:

-inferior  MI
- perforated viscous
- impending aortic aneurysm
- biliary colic
- ureteric colic

د.ناجي حومش

#Surgery

Left hemi liver can be enlarged but not felt when?
If it was soft and enlarged as in

Congestion
Hepatitis
Obstructive jaundice
د.ناجي

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In abdominal pain we ask about Headache during the pain and blurring of vision...
Why?

To exclude Pheochromocytoma

د. ناجي حومش

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حومش يعجبه نسوي بالطريقة الثانية.

Remember:

-Petersen's defect is defined as the potential space between the small bowel limbs and the transverse mesocolon after any type of gastrojejunostomy, especially the Roux-en-Y anastomosis.

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Remember:

-The most common nerve injured during open hernia repair is the ilioinguinal nerve.

-The most common nerve injured during laparoscopic repair is the lateral femoral cutaneous nerve.

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