In abdominal pain we ask about Headache during the pain and blurring of vision...
Why?
To exclude Pheochromocytoma
د. ناجي حومش
#Surgery
Why?
To exclude Pheochromocytoma
د. ناجي حومش
#Surgery
Quick Notes
Methods to elicit MURPHY’S SIGN: 1)Patient in upright/sitting position, the right hand of the examiner curls up under the right costal margin (or extended fingers with moderate pressure) of the patient at the tip of the ninth rib and patient is requested…
حومش يعجبه نسوي بالطريقة الثانية.
Diagnostic features of dermoid cyst:
1.Cystic swelling
2.Not transilluminant
3.The skin can be pinched (no punctum and therefore no tethering)
They are seen deep to the skin in the subcutaneous tissue
4.A bony depression or defect may be felt 5.Intracranial communication may be there.
#Surgery
1.Cystic swelling
2.Not transilluminant
3.The skin can be pinched (no punctum and therefore no tethering)
They are seen deep to the skin in the subcutaneous tissue
4.A bony depression or defect may be felt 5.Intracranial communication may be there.
#Surgery
Sites of the portosystemic anastomosis or shunts:
Lower end of esophagus
Around the umblicus
Anal canal
Bare area of liver
Retroperitoneal space.
#Surgery
Lower end of esophagus
Around the umblicus
Anal canal
Bare area of liver
Retroperitoneal space.
#Surgery
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.
#Surgery
-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.
#Surgery
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.
#Surgery
-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.
#Surgery
What is the syndrome associated with sebaceous cyst?
-Gardner’ssyndrome:
Osteomas
Intestinal polyposis
Sebaceous cyst.
#Surgery
-Gardner’ssyndrome:
Osteomas
Intestinal polyposis
Sebaceous cyst.
#Surgery
Differential diagnoses of thyroglossal cyst:
1-Median sublingual dermoid
2-Enlarged submental lymph node
3-Subhyoid bursa
-4-Enlarged Delphian node
5-Solitary thyroid nodule
6-Thyroid cyst.
#Surgery
1-Median sublingual dermoid
2-Enlarged submental lymph node
3-Subhyoid bursa
-4-Enlarged Delphian node
5-Solitary thyroid nodule
6-Thyroid cyst.
#Surgery
This is an example of a thyroid case examination:
Local:
Inspection:
-There is a single swelling in the right. anterior triangle of the neck, about 2×3 cm in size , oval in shape, with irregular surface, no skin changes as redness dilated veins, sinus, scar or edema and no pulsation .
-It's movable with deglutition and does not move by tongue protrusion.
Local:
Inspection:
-There is a single swelling in the right. anterior triangle of the neck, about 2×3 cm in size , oval in shape, with irregular surface, no skin changes as redness dilated veins, sinus, scar or edema and no pulsation .
-It's movable with deglutition and does not move by tongue protrusion.
Palpation:
-There is neither hottness, tenderness. nor thrill.
-The trachea is central and both carotids are palpable.
-By palpating the left side of the neck, there is no palpable swelling.
-By palpation of the right side, here is a single lump in right anterior triangle of the neck, about 2×3cm size, oval in shape, with irregular surface and hard consistency, not mobile, border is ill-defined. The skin isn't attached, it's not fixed to the underlying structures such as SCM muscle, and I can get below it.
-By palpation of lymph nodes, there are about two palpable lymph nodes in the right anterior neck triangle, painless, rough, hard, and fixed.
Percussion:
-Resonant on sternum.
Ascultation:
-There is no audible bruit over the carotid or swelling.
-There is neither hottness, tenderness. nor thrill.
-The trachea is central and both carotids are palpable.
-By palpating the left side of the neck, there is no palpable swelling.
-By palpation of the right side, here is a single lump in right anterior triangle of the neck, about 2×3cm size, oval in shape, with irregular surface and hard consistency, not mobile, border is ill-defined. The skin isn't attached, it's not fixed to the underlying structures such as SCM muscle, and I can get below it.
-By palpation of lymph nodes, there are about two palpable lymph nodes in the right anterior neck triangle, painless, rough, hard, and fixed.
Percussion:
-Resonant on sternum.
Ascultation:
-There is no audible bruit over the carotid or swelling.
Very important:
After local examination of thyroid, look for:
-Signs of Thyrotoxicosis"1°&2°"
-Signs of Myxedema.
-Signs of Retrosternal extension.
-Signs of Metastasis.
After local examination of thyroid, look for:
-Signs of Thyrotoxicosis"1°&2°"
-Signs of Myxedema.
-Signs of Retrosternal extension.
-Signs of Metastasis.
Signs of Primary Thyrotoxicosis:
1. Eye signs
2. Tachycardia
3. Tremors
4. Moist skin
5. Thyroid bruit
6. Peritibial myxedema.
Here eye signs are more common.
-Signs of Secondary Thyrotoxicosis:
1-Signs of cardiac failure:
-Edema of ankles
-Orthopnea
2-Eye signs: Only lid lag and lid retraction can be seen
• No tremor • No exophthalmos, only seen in Primary type "Grave's disease".
Here CVS signs are more common than eye signs.
1. Eye signs
2. Tachycardia
3. Tremors
4. Moist skin
5. Thyroid bruit
6. Peritibial myxedema.
Here eye signs are more common.
-Signs of Secondary Thyrotoxicosis:
1-Signs of cardiac failure:
-Edema of ankles
-Orthopnea
2-Eye signs: Only lid lag and lid retraction can be seen
• No tremor • No exophthalmos, only seen in Primary type "Grave's disease".
Here CVS signs are more common than eye signs.
Signs of Myxedema"Hypothyroidism":
-Obese
-Dry inelastic skin
-Macroglossia
-Mask like facies
-Loss of hair in lateral eye brow
-Hoarseness of voice
-Pseudo myotonic reflex (delayed ankle jerk); also called ‘hung up’ reflex.
-Obese
-Dry inelastic skin
-Macroglossia
-Mask like facies
-Loss of hair in lateral eye brow
-Hoarseness of voice
-Pseudo myotonic reflex (delayed ankle jerk); also called ‘hung up’ reflex.
Signs of Retrosternal extension:
-As above examination, you can obtain them.
-Look at face, neck, upper chest for dilated veins, congestion, edema, puffiness, palpate tracheal rigns in SS notch, also below the lump, percuss over manibrium sterni for dullness, ask the patient to elevate both limbs for Pemberton's sign.
-As above examination, you can obtain them.
-Look at face, neck, upper chest for dilated veins, congestion, edema, puffiness, palpate tracheal rigns in SS notch, also below the lump, percuss over manibrium sterni for dullness, ask the patient to elevate both limbs for Pemberton's sign.
Signs of Metastasis:
1-Palpate neck of both sides for enlarged LN's.
2-Skull for hard nodules.
3-Look for bony deformity, tenderness in long bones.
4-Examine the abdomen for liver enlargement and ascites.
5-Examine the chest for signs of effusion and consolidation.
1-Palpate neck of both sides for enlarged LN's.
2-Skull for hard nodules.
3-Look for bony deformity, tenderness in long bones.
4-Examine the abdomen for liver enlargement and ascites.
5-Examine the chest for signs of effusion and consolidation.
Quick Notes
This is an example of a thyroid case examination: Local: Inspection: -There is a single swelling in the right. anterior triangle of the neck, about 2×3 cm in size , oval in shape, with irregular surface, no skin changes as redness dilated veins, sinus,…
نفس ما شرح د. رمزي.
من الڤيديو الهندي، الشلوف، Long case.
من الڤيديو الهندي، الشلوف، Long case.