Common OSCE cases & important discussion notes 13 pages.

Urgent cholecystectomy.
• if unfit for surgery →(percutaneous cholecystostomy)
As temporary decompression until pt become fit

pt become [jaundice + pale stool +dark urine] = CBD stone.
Do →LFT U/S + ERCP or MRCP.
ERCP to remove! Stone → later do cholecystectomy.
If ERCP is not possible →do open surgery:
(CBD exploration + T-tube cholecystectomy

Alkaline phosphate ⇒
(bone /WBC/intestine/placenta/kidneys

ALT ⇒ Specific for liver only.
AST⇒ Also for skeletal and cardic muscle .

Liver injury ⇒ ALT & AST
Billiry injury ⇒ ALP &GGT

MRCP is investigation of choice in pt with dilated duct on U/S.

ERCP is diagnostic & therapeutic but more invasive.

Acute cholangitis
Classically Charcot’s triad:
RHC pain +fever + obstructive jaundice

antithyroid drugs (thiouracil & carbimazole).

Pain, vomiting, dehydration, lying forward (Acute pancritis)

Mid ingiuanal point (femoral artary) midway between ASIS and symphysis pubis

Mid point of inguianal canal (internal ring) half an inch between pubic tubercal and ASIS

In pediatric: (Diffuse goiter + Hypothyroidism) due to congenital enzyme
deficiency →"Peroxidase (common)"
→"Dehydrogenase (rare)"
C/P: Deafness + Autism + Goiter

All the structure of abdomen may hernited except pancreas and spleen

Shutter mechanism assist to protect the body from herni by cotraction the internal ring (Facia transvercels)

Pomberton sign ⇒ raise upper limb up to see if there is dilated viens