Third day fever:
-If a patient is developing fever on the third postoperative day of surgery, suspect septic foci in the IV cannula.
#Surgery
-If a patient is developing fever on the third postoperative day of surgery, suspect septic foci in the IV cannula.
#Surgery
Varicose vein: (WHO Definition)
-Abnormally dilated saccular or cylindrical superficial veins which can be circumscribed or segmental.
#Surgery
-Abnormally dilated saccular or cylindrical superficial veins which can be circumscribed or segmental.
#Surgery
Seddon’s Classification - Types of nerve injury:
•Neurapraxia
Axons are intact. Spontaneous recovery is complete.
•Axonotmesis:
Axons divided.Connective tissue intact. Wallerian degeneration occurs. Axons then regenerate slowly.
•Neurotmesis :
Whole nerve severed. Recovery may occur if cut ends are apposed.
#Surgery
•Neurapraxia
Axons are intact. Spontaneous recovery is complete.
•Axonotmesis:
Axons divided.Connective tissue intact. Wallerian degeneration occurs. Axons then regenerate slowly.
•Neurotmesis :
Whole nerve severed. Recovery may occur if cut ends are apposed.
#Surgery
In the normal adult erect film, usually upto 3 fluid levels are normal. They are:
1.One at the fundus of the stomach
2.One at the duodenal cap
3.One in the terminal ileum.
1.One at the fundus of the stomach
2.One at the duodenal cap
3.One in the terminal ileum.
Porcelain gallbladder:
-Calcification of the gallbladder in plain X-ray is called porcelain gallbladder.
-The importance of this appearance is an association of carcinoma in up to 25% of patients.
#Surgery
-Calcification of the gallbladder in plain X-ray is called porcelain gallbladder.
-The importance of this appearance is an association of carcinoma in up to 25% of patients.
#Surgery
Clinical features of tension pneumothorax:
•Acute dyspnea
•Distended neck veins
•Weak pulse
•Low blood pressure
•Tracheal shift
•Shifting of the apex beat •Hyperresonance on the affected hemithorax
•Absent breath sounds on the same side.
How to confirm tension pneumothorax?
-It is a clinical diagnosis and treatment must be instituted urgently without wasting time for radiology!
#Surgery
•Acute dyspnea
•Distended neck veins
•Weak pulse
•Low blood pressure
•Tracheal shift
•Shifting of the apex beat •Hyperresonance on the affected hemithorax
•Absent breath sounds on the same side.
How to confirm tension pneumothorax?
-It is a clinical diagnosis and treatment must be instituted urgently without wasting time for radiology!
#Surgery
Surgical emphysema:
•It is the presence of air in the tissues •It requires a breach of air containing viscus which is in communication with soft tissues and the generation of positive pressure to push the air along tissue planes.
What is the physical sign of surgical emphysema?
-Crepitus, due to presence of gas in the subcutaneous tissue.
#Surgery
•It is the presence of air in the tissues •It requires a breach of air containing viscus which is in communication with soft tissues and the generation of positive pressure to push the air along tissue planes.
What is the physical sign of surgical emphysema?
-Crepitus, due to presence of gas in the subcutaneous tissue.
#Surgery
Why appendicectomy is contraindicated in appendicular mass?
1.Immediate appendicectomy is technically more difficult
2.Fear of disturbing the natural barrier present in the mass.
3.The mass will resolve without surgery (90% will resolve with conservative treatment).
4.Operation can always be resorted to, should the initial conservative trial fail.
#Surgery
1.Immediate appendicectomy is technically more difficult
2.Fear of disturbing the natural barrier present in the mass.
3.The mass will resolve without surgery (90% will resolve with conservative treatment).
4.Operation can always be resorted to, should the initial conservative trial fail.
#Surgery
-Commonest organ failure in severe Acute pancreatitis is respiratory.
-Biliary tract disease is the commonest cause of acute pancreatitis.
-Magnitude of amylase elevation is not related to severity of the pancreatitis. It increases once symptoms appear for 12–24 hours then decreases in 6 days.
-Persistent elevation suggests complications like pseudocyst, ascites and abscess formation.
#Surgery
-Biliary tract disease is the commonest cause of acute pancreatitis.
-Magnitude of amylase elevation is not related to severity of the pancreatitis. It increases once symptoms appear for 12–24 hours then decreases in 6 days.
-Persistent elevation suggests complications like pseudocyst, ascites and abscess formation.
#Surgery
-Decrease serum calcium level is worst prognostic indicator of pancreatitis.
-Open surgery is the gold standard for infected pancreatic necrosis.
-Spiral CT (CECT–contrast enhanced CT) is better—gold standard.
-Serum lipase more specific than amylase.
-Serum lipase level after rise persists for longer period than amylase.
-Serum lactescence (related to triglyceride met abolism)—Most specific in hereditary hyperlipidaemia or alcohol pancreatitis.
-In Acute Pancreatitis: Sudden onset of upper abdominal pain which is referred to back. Pain is severe, agonizing and refractory. Pain may be relieved or reduced by leaning forward.
#Surgery
-Open surgery is the gold standard for infected pancreatic necrosis.
-Spiral CT (CECT–contrast enhanced CT) is better—gold standard.
-Serum lipase more specific than amylase.
-Serum lipase level after rise persists for longer period than amylase.
-Serum lactescence (related to triglyceride met abolism)—Most specific in hereditary hyperlipidaemia or alcohol pancreatitis.
-In Acute Pancreatitis: Sudden onset of upper abdominal pain which is referred to back. Pain is severe, agonizing and refractory. Pain may be relieved or reduced by leaning forward.
#Surgery
Pancreatic pseudocyst
◼️This refer to the collection of pancreatic secretions in a well defined wall of granulation tissue or fibrous tissue.
◼️It forms after trauma, acute pancreatitis or chronic pancreatitis, basically anything that lead to duct disruption and escape of pancreatic secretions, it requires 4 weeks or more from the index event for the wall to fully mature.
◼️Most pseudocysts are located in the lesser sac, unusual locations do occur however like in the spleen or even the chest, but this is rare, most do go away on their own, but those over 6 cm, lasting over 12 weeks or occur due to chronic pancreatitis are unlikely to resolve spontaneously.
◼️When appropriate drainage should be done, this can be done by simple percutaneous aspiration or by cystogastrostomy which are nowadays usually done by endoscopy.
◼️Above table lists possible complications of pseudocysts.
#Surgery
◼️This refer to the collection of pancreatic secretions in a well defined wall of granulation tissue or fibrous tissue.
◼️It forms after trauma, acute pancreatitis or chronic pancreatitis, basically anything that lead to duct disruption and escape of pancreatic secretions, it requires 4 weeks or more from the index event for the wall to fully mature.
◼️Most pseudocysts are located in the lesser sac, unusual locations do occur however like in the spleen or even the chest, but this is rare, most do go away on their own, but those over 6 cm, lasting over 12 weeks or occur due to chronic pancreatitis are unlikely to resolve spontaneously.
◼️When appropriate drainage should be done, this can be done by simple percutaneous aspiration or by cystogastrostomy which are nowadays usually done by endoscopy.
◼️Above table lists possible complications of pseudocysts.
#Surgery
An appendicectomy specimen with a large faecolith on the right hand side, the distal part appears swollen and hyperemic with extensive adhesions, Faecolith obstruction is considered to be a risk factor for appendix perforation, in this specimen there was a perforation in the middle third of the appendix.
#Surgery
#Surgery
BEST DIAGNOSTIC TESTS FOR ANEMIAS
-Iron deficiency anemia =====> Dec ferritin???
-Thalesemia =====> Hb Electrophoresis
-Lead Poisoning =====> Lead level Blood+Urine
-B12 Def =====> Increased serum methylmalonic acid
-Folate def =====> RBCs Folate levels (not "blood folate levels")
-Pernicious Anemia =====> Antibodies against intrinsic factor
- PNH =====> ctyometry
-Sickle Cell =====> Hb electrophoresis
-G6PD def =====> RBC enzyme essay
-Pyruvate kinase disease =====> RBC enzyme assay
-Aplastic anemia =====> Bone marrow examination
-Hemolytic anemia =====> Decreased haptoglobin (not "increased reticulocytosis").
#Medicine
-Iron deficiency anemia =====> Dec ferritin???
-Thalesemia =====> Hb Electrophoresis
-Lead Poisoning =====> Lead level Blood+Urine
-B12 Def =====> Increased serum methylmalonic acid
-Folate def =====> RBCs Folate levels (not "blood folate levels")
-Pernicious Anemia =====> Antibodies against intrinsic factor
- PNH =====> ctyometry
-Sickle Cell =====> Hb electrophoresis
-G6PD def =====> RBC enzyme essay
-Pyruvate kinase disease =====> RBC enzyme assay
-Aplastic anemia =====> Bone marrow examination
-Hemolytic anemia =====> Decreased haptoglobin (not "increased reticulocytosis").
#Medicine
Sigmoid colon: is the commonest site of volvulus, tumor and diverticulosis because of its shape and fecal material storage .
#Surgery
#Surgery
Vomiting: the forcible ejection or expulsion of gastric contents as a result of synchronous contraction of diaphragm,intercostal and abdominal muscles with relaxation of LOS.
Regurgitation and reflux are often used synonymously. It is helpful to differentiate between them, although it is not always possible.
Regurgitation should strictly refer to the return of oesophageal contents from above a functional or mechanical obstruction.
Reflux is the passive return of gastroduodenal contents to the mouth as part of the symptomatology of gastro-oesophageal reflux disease (GORD).
#Surgery
Regurgitation and reflux are often used synonymously. It is helpful to differentiate between them, although it is not always possible.
Regurgitation should strictly refer to the return of oesophageal contents from above a functional or mechanical obstruction.
Reflux is the passive return of gastroduodenal contents to the mouth as part of the symptomatology of gastro-oesophageal reflux disease (GORD).
#Surgery
How to differentiatebetween submandibular gland stones and submandibular LN Enlargement?
-History of pain and swelling that increase after eating
-Swelling is solitary and can't be rolled over the mandible. مايقدرش يتحرك فوق.
-Inspection of the mouth floor may reveal redness of duct orifice.
-Bimanual palpation reveals swelling is filling the floor of the mouth.
#Surgery
-History of pain and swelling that increase after eating
-Swelling is solitary and can't be rolled over the mandible. مايقدرش يتحرك فوق.
-Inspection of the mouth floor may reveal redness of duct orifice.
-Bimanual palpation reveals swelling is filling the floor of the mouth.
#Surgery
In submandibular gland stones:
Plain x-ray (closed mouth view):
-Stone in the submandibular gland is radio-opaque in 8o ٪ of cases.
Sialogram:
-Shows the radiolucent stones.
بعكس الـ Parotid stones اللي هن أصلاً rare، وكذا يكونين Radiolucent.
#Surgery
Plain x-ray (closed mouth view):
-Stone in the submandibular gland is radio-opaque in 8o ٪ of cases.
Sialogram:
-Shows the radiolucent stones.
بعكس الـ Parotid stones اللي هن أصلاً rare، وكذا يكونين Radiolucent.
#Surgery
Cullen's sign:
-Periumbilical eccymoses seen in Retroperitoneal hemorrhage mostly with Acute pancreatitis.
Grey turner's sign :
-Seen with retroperitoneal hemorrhage , ecchymosis or dislocation of flank as result of dissecting blood from retroperitoneum as in AP.
Kehr's sign:
-Seen with splenic rupture, it is severe left shoulder pain (referred pain from diaphragmatic irritation).
#Surgery
-Periumbilical eccymoses seen in Retroperitoneal hemorrhage mostly with Acute pancreatitis.
Grey turner's sign :
-Seen with retroperitoneal hemorrhage , ecchymosis or dislocation of flank as result of dissecting blood from retroperitoneum as in AP.
Kehr's sign:
-Seen with splenic rupture, it is severe left shoulder pain (referred pain from diaphragmatic irritation).
#Surgery
Virchow's node:
Metastatic tumor to left supraclavicular node (usually due to gastric cancer).
#Surgery
Metastatic tumor to left supraclavicular node (usually due to gastric cancer).
#Surgery