In case of Acute Upper GIT bleeding:

-Risk scoring systems have been developed to stratify the risk of needing endoscopic therapy or of having a poor outcome.

-The advantage of the Blatchford score is that it may be used before endoscopy to predict the need for intervention to treat bleeding.
-Low scores (2 or less) are associated with a very low risk of adverse outcome.

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•Mackler triad (esp. in Boerhaave syndrome) in Esophageal Perforation:

1-Vomiting and/or retching
2-Severe retrosternal pain that often radiates to the back
3-Subcutaneous or mediastinal emphysema:
crepitus in the suprasternal notch and neck region or crunching/crackling sound on chest auscultation (Hamman sign).

#Surgery

•Extra-esophageal symptoms (respiratory )of GERD:

1-Reflux-induced Asthma.
2-Chronic Cough.
3-Aspiration pneumonia.
4-Recurrent laryngitis.
5-Pulmonary fibrosis.
6-Hiccups.
7-Pharyngeal & laryngeal irritation horsiness of voice.
8-Otitis media.

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•Complications of Barrett’s oesophagus:

1-Ulcerations and stricture
2-Dysphagia
3-Bleeding
4-Perforation
5-Adenocarcinoma of O-G junction (25 times more common).

#Surgery

Note:

-Normal resting LOS pressure is 10–25 mmHg.
-During swallowing, pressure drops to 1–3 mmHg for few seconds (10 seconds).

#Surgery

CONTRAST STUDY OF OESOPHAGUS:

Types
1.Barium swallow using barium sulphate (thick paste).

2.Using water-soluble contrast like ‘Gastrografin’.

#Surgery

•Indications of Barium swallow:

1-Dysphagia due to motility disorder like achalasia, diffuse oesophageal spasm.
2-Dysphagia due to mechanical causes like carcinoma, benign strictures and neoplasms, external compression.
3-Pharyngeal pouch and other diverticula.
4-GORD.

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#Surgery

•Indications of Water-soluble contrast radiograph:

1-In suspected oesophageal perforation.
2-Leaking oesophageal anastomosis.

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•Important Findings in Barium Swallow


1-Achalasia cardia—‘Bird beak’ appearance, as the oesophagus is grossly dilated above an apparent narrowing at the cardia. In longstanding cases—‘sigmoid oesophagus’.
2-Diffuse oesophageal spasm—Corkscrew appearance.
3-GORD—shows reflux when done in Trendelen burg’s position.
4-Oesophageal carcinoma—irregular stenosing lesion with shouldering (‘Rat tail’ is a fluoroscopic finding).
5-Pharyngeal pouch—demonstration of the pouch.
6-External compression—indentation of barium column by superior or posterior mediastinal mass, enlarged left atria as in mitral stenosis.

#Surgery
#Radiology

•In Esophageal Carcinoma:

-It is 6th most common cancer in the world.
-It is less than 1% of all cancers.
-It is 7% of all GI malignancies.
-Common in:
Middle third—50%.
Lower third—33%.
Upper third—17%.

-Recent onset of dysphagia is the commonest feature.

#Surgery
#GIT

•Helicobacter pylori infection, which can cause stomach cancer, has not been associated with esophageal cancer.

#Surgery

•24-hour pH recording is the ‘gold standard’ for diagnosis of GORD.

#Medicine

Saphina varix :

-It is a dilatation of the termination of the long saphinous vein or one of its major tributaries.
-It shows as a blue tinged bulge in the groin that disappears on lying flat .

#Surgery
#Vascular

•Gaiter region

The skin over the lower medial third of the leg ( skin just above the medial malleolus ) .

It's the most common site for venous ulcerations.

#Surgery
#Vascular

Corona phlebectatcia " Ankle flare ",
When There's considerable dilatation of the intercutaneous veins BELOW the ankle in limbs with venous hypertension.

#Surgery
#Vascular

Ogilvie syndrome .

is the acute dilatation of the colon in the absence of any mechanical obstruction in severely ill patients.

This is a CT-Scan showing a coronal section of the abdomen of an elderly woman with Ogilvie syndrome .

Acute colonic pseudo-obstruction is characterized by massive dilatation of the cecum (diameter > 10 cm) and right colon on abdominal X-ray.
It is a type of megacolon, sometimes referred to as "acute megacolon" to distinguish it from toxic megacolon.

#Surgery
#GIT

Once you see the Earthy face of a Renal failure patient , you will never forget it.

#Medicine
#UT

Remember:

-The best fluid replacement incase of hemorrhagic shock is Cross matched blood .

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-The most common cause of hypercalcemia in outpatients is hyperparathyroidism.

-The most common cause of Hypercalcemia in hospitalised patients is malignancy .

-The most common malignancy leading to hypercalcemic crisis is breast cancer.

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#Endocrine

•Whipple's triad

-Typical presentation of insulinomas.
Consists of :

1-Symptomatic fasting hypoglycemia.

2-Plasma glucose less than 50 mg/dl during the attack .

3-Dramatic improvement after administration of glucose.

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#Endocrine

Courvoisier sign aka Courvoisier-Terrier sign:

-It states that in a patient with painless jaundice and an enlarged gallbladder (or right upper quadrant mass), the cause is unlikely to be gallstones and therefore presumes the cause to be an obstructing pancreatic or biliary neoplasm ( mostly carcinoma of head of the pancreas ) until proven otherwise .

#Surgery
#Biliary