How to differentiate between acute appendicitis and mesenteric lymph adenitis ?
-In mesenteric lymph adenitis the patient has shifting tenderness ( the patient hasPain localize tothe RIF, When he terns to the other side the pain shift with the direction of the movement) also the patient may have tonsillitis.
#Appendix
#Surgery
-In mesenteric lymph adenitis the patient has shifting tenderness ( the patient hasPain localize tothe RIF, When he terns to the other side the pain shift with the direction of the movement) also the patient may have tonsillitis.
#Appendix
#Surgery
-Analgesics is contraindicated if acute appendicitis is suspected to avoid masking of diagnosis.
#Surgery
#Surgery
Differential Diagnosis for Epigastric Abdominal Pain:
1- Gastroenteritis:-
History and physical:-
Nausea, extensive vomiting, diarrhea, myalgia, fever, mild abdominal tenderness
2-Acute gastritis:-
History and physical:-
Burning/gnawing epigastric pain, NSAID use, mild abdominal tenderness
3-Acute cholecystitis:-
History and physical:-
Right upper quadrant/epigastric pain radiating to around the right back, nausea, vomiting, fever, Murphy’s sign
4-Peptic ulcer disease (PUD)
History and physical:-
Intermittent burning epigastric pain that is better (duodenal ulcer) or worse (gastric ulcer) with food intake, nausea, Helicobacter pylori infection, NSAID use, steroids
5-Perforated ulcer :-
History and physical:-
Initial epigastric pain, followed by diffuse tenderness, abdominal rigidity, rebound tenderness
6-Pancreatitis:-
History and physical:-
Epigastric pain radiating to the back, nausea, vomiting, anorexia, fever, tachycardia, cholelithiasis, alcohol abuse
7-Appendicitis:-
History and physical:-
Periumbilical pain migrating toward the right lower quadrant (McBurney’s point), associated with nausea, vomiting, anorexia, fever, Rovsing’s sign, psoas sign
8-Small bowel obstruction :-
History and physical:-
Adhesions, hernia, neoplasms, dilated loops of bowel with air fluid levels, absence of distal colonic gas on plain radiograph
9-Mesenteric ischemia :-
History and physical:-
“Severe abdominal pain out of proportion to physical exam,” nausea, most often cardiac embolus to superior mesenteric artery from atrial fibrillation, bloody diarrhea in severe cases
10-Ruptured AAA :-
History and physical:-
Severe abdominal/back/left flank pain, pulsatile abdominal mass, hypotension, elderly male smoker
11-Referred pain from myocardial infarction:-
History and physical:-
Atypical presentation more common in women and diabetics, cardiovascular disease, obesity, hypercholesterolemia.
#Surgery
1- Gastroenteritis:-
History and physical:-
Nausea, extensive vomiting, diarrhea, myalgia, fever, mild abdominal tenderness
2-Acute gastritis:-
History and physical:-
Burning/gnawing epigastric pain, NSAID use, mild abdominal tenderness
3-Acute cholecystitis:-
History and physical:-
Right upper quadrant/epigastric pain radiating to around the right back, nausea, vomiting, fever, Murphy’s sign
4-Peptic ulcer disease (PUD)
History and physical:-
Intermittent burning epigastric pain that is better (duodenal ulcer) or worse (gastric ulcer) with food intake, nausea, Helicobacter pylori infection, NSAID use, steroids
5-Perforated ulcer :-
History and physical:-
Initial epigastric pain, followed by diffuse tenderness, abdominal rigidity, rebound tenderness
6-Pancreatitis:-
History and physical:-
Epigastric pain radiating to the back, nausea, vomiting, anorexia, fever, tachycardia, cholelithiasis, alcohol abuse
7-Appendicitis:-
History and physical:-
Periumbilical pain migrating toward the right lower quadrant (McBurney’s point), associated with nausea, vomiting, anorexia, fever, Rovsing’s sign, psoas sign
8-Small bowel obstruction :-
History and physical:-
Adhesions, hernia, neoplasms, dilated loops of bowel with air fluid levels, absence of distal colonic gas on plain radiograph
9-Mesenteric ischemia :-
History and physical:-
“Severe abdominal pain out of proportion to physical exam,” nausea, most often cardiac embolus to superior mesenteric artery from atrial fibrillation, bloody diarrhea in severe cases
10-Ruptured AAA :-
History and physical:-
Severe abdominal/back/left flank pain, pulsatile abdominal mass, hypotension, elderly male smoker
11-Referred pain from myocardial infarction:-
History and physical:-
Atypical presentation more common in women and diabetics, cardiovascular disease, obesity, hypercholesterolemia.
#Surgery
-In males, first decide whether the lump is a hernia or a true scrotal lump by seeing if you can ‘get above it’, namely feel its upper edge with a normal spermatic cord above.
-If you can, it is a scrotal swelling and not a hernia.
-If the lump has no upper edge because it passes into the inguinal canal, it is a hernia.
#Hernia
#Surgery
-If you can, it is a scrotal swelling and not a hernia.
-If the lump has no upper edge because it passes into the inguinal canal, it is a hernia.
#Hernia
#Surgery
•Why is indirect inguinal hernia more common in right side ?
Due to delayed descend of right testis , slower closure of a patent processus vaginalis on the right side compared to the left.
It's almost about one month difference.
#Surgery
Due to delayed descend of right testis , slower closure of a patent processus vaginalis on the right side compared to the left.
It's almost about one month difference.
#Surgery
•What's the difference between osteoporosis and osteomalasia ?
-In osteoporosis, bone mass decreases, but the ratio of bone mineral to bone matrix is normal.
-In osteomalacia, the ratio of bone mineral to bone matrix is low.
#Surgery
-In osteoporosis, bone mass decreases, but the ratio of bone mineral to bone matrix is normal.
-In osteomalacia, the ratio of bone mineral to bone matrix is low.
#Surgery
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
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
-Gall stone may obstruct the ileum leading to what called- Gall stone ileus.
Or
-Leads to gastric outlet obstruction is called- Bouverte's syndrome.
#Surgery
Or
-Leads to gastric outlet obstruction is called- Bouverte's syndrome.
#Surgery
Triple asessment of the breast:
1-History and examination
2-US and Mammography
3-Trucut biopsy.
Good exposure in breast examination is from umbilicus upward,Why?
-Because the lymph from the level of umbilicus upward comes to axilla.
#Surgery
1-History and examination
2-US and Mammography
3-Trucut biopsy.
Good exposure in breast examination is from umbilicus upward,Why?
-Because the lymph from the level of umbilicus upward comes to axilla.
#Surgery
•Murphy's Triad:
-It is associated with acute appendicitis, a medical emergency which presents with:
1-Lower right abdominal pain
2-Nausea and vomiting
3-Fever.
•Murphy's sign:
-It is useful for differentiating pain in the right upper quadrant.
-Typically, it is positive in acute cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.
•Murphy's test
-It is a costovertebral angle (CVA) tenderness that results from touching the region inside of the costovertebral angle.
•Murphy's drip:
-It is a rectal infusion apparatus to administer the medical procedure of proctoclysis, also known as rectoclysis.
#Surgery
-It is associated with acute appendicitis, a medical emergency which presents with:
1-Lower right abdominal pain
2-Nausea and vomiting
3-Fever.
•Murphy's sign:
-It is useful for differentiating pain in the right upper quadrant.
-Typically, it is positive in acute cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.
•Murphy's test
-It is a costovertebral angle (CVA) tenderness that results from touching the region inside of the costovertebral angle.
•Murphy's drip:
-It is a rectal infusion apparatus to administer the medical procedure of proctoclysis, also known as rectoclysis.
#Surgery
•Hartmann's procedure:
-It is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy.
•Hartmann's solution:
-Is Ringer's lactate solution.
•Hartmann's pouch:
-Dilated infandibulum of Gall bladder.
#Surgery
-It is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy.
•Hartmann's solution:
-Is Ringer's lactate solution.
•Hartmann's pouch:
-Dilated infandibulum of Gall bladder.
#Surgery
-Trauma to knee joint then after one to five days swelling is developed this indicates synovial effusion .
-Trauma to knee joint then after 5 minutes swelling is devloped this indicates hemarthrosis.
-Trauma to knee joint with wounds then after 2 weeks swelling is devloped with pain, tendrness, redness, fever ,limitation of movement this indicates abscess.
-Trauma to soft tissues then swelling is devloped this indicates hematoma.
#Surgery
-Trauma to knee joint then after 5 minutes swelling is devloped this indicates hemarthrosis.
-Trauma to knee joint with wounds then after 2 weeks swelling is devloped with pain, tendrness, redness, fever ,limitation of movement this indicates abscess.
-Trauma to soft tissues then swelling is devloped this indicates hematoma.
#Surgery
Surgical Triads
1. Shock Triad :
-Hypotention ( leading to hypoperfusion of tissues )+ tachycardia + low urine output.
2. Triad of death :
-Hypocoaugulopathy + acidosis + hypothermia.
3. Virchow Triad:
-Endothelial damage + venous stasis + hypercoagulability.
4. Charcot's Triad ( obstructive jaundice ) :
-Upper abdominal pain + fever + juandice.
-Reynold pentad = Charcot triad + shock + nervous disturbances "AMS".
5. Beck's Triad ( cardiac tamponade ):
-Hypotention + ↑ JVP + soft heart sounds.
6. Whipple's Triad ( insulinoma ) :
-Symptoms of hypoglycemia + FBS< 50 + relief after eating.
7. Cushing's Triad (↑ICP):
-Badycardia + irregular breathing + ↑pulse pressure
8. Samter's Triad :
-Asthma + aspirin allergy + nasal polyps.
9. Unhappy Triad ( knee major injury ) :
-Anterior cruciate lig +medial collateral ligament +medial meniscus.
10. Sandbolm Triad ( hemobilia ) :
-Obstructive jaundice + biliary colic + melena.
11. Dieulafoy triad ( acute appendicitis ) :
-Hyperasthesia + tenderness + guarding over McBurney point.
12. Bergman triad ( fat emboli syndrome ) :
-Petechia + dyspnea + mental changes.
13. Meckler triad (Boerhaav syndrome ):
-Hematemesis + abdominal &chest pain + emphysema.
14. Saint triad :
-Hiatal hernia + gall stones + diverticulosis.
15. Tetany triad :
-Convulsion + carpopedal spasms + stridor.
16. Plummer-Vinson triad :
-Dysphagia + Iron DA + esophageal webs.
#Surgery
1. Shock Triad :
-Hypotention ( leading to hypoperfusion of tissues )+ tachycardia + low urine output.
2. Triad of death :
-Hypocoaugulopathy + acidosis + hypothermia.
3. Virchow Triad:
-Endothelial damage + venous stasis + hypercoagulability.
4. Charcot's Triad ( obstructive jaundice ) :
-Upper abdominal pain + fever + juandice.
-Reynold pentad = Charcot triad + shock + nervous disturbances "AMS".
5. Beck's Triad ( cardiac tamponade ):
-Hypotention + ↑ JVP + soft heart sounds.
6. Whipple's Triad ( insulinoma ) :
-Symptoms of hypoglycemia + FBS< 50 + relief after eating.
7. Cushing's Triad (↑ICP):
-Badycardia + irregular breathing + ↑pulse pressure
8. Samter's Triad :
-Asthma + aspirin allergy + nasal polyps.
9. Unhappy Triad ( knee major injury ) :
-Anterior cruciate lig +medial collateral ligament +medial meniscus.
10. Sandbolm Triad ( hemobilia ) :
-Obstructive jaundice + biliary colic + melena.
11. Dieulafoy triad ( acute appendicitis ) :
-Hyperasthesia + tenderness + guarding over McBurney point.
12. Bergman triad ( fat emboli syndrome ) :
-Petechia + dyspnea + mental changes.
13. Meckler triad (Boerhaav syndrome ):
-Hematemesis + abdominal &chest pain + emphysema.
14. Saint triad :
-Hiatal hernia + gall stones + diverticulosis.
15. Tetany triad :
-Convulsion + carpopedal spasms + stridor.
16. Plummer-Vinson triad :
-Dysphagia + Iron DA + esophageal webs.
#Surgery