اسئله الدكاتره من سنه رابعه حتى سادسه🤘

@surgery565

د/ خالد الكحلاني

🐥Renal case "
Investigations:
°Urine analysis
°urine culture
°CBC
°RFT
°US
about urine culture not routinely for every pt just for once who complain of dysuria ,, hesitancy and so on or for pt that you suggest he has UTI

✨shape of stone either stag horne...

✨How to read an X-ray of pelvis ?!
firstly you should hold it in a correct way and know the right and left sides by mirror image according to yourself
لازم تعتمد هذه الطريقة لأنو احيانا ما يحددش الي عمل الأشعة هل يمين او يسار واحيانا يعكس..
وفي بعضهم يعتمدوا على ال organs shadow مثلا يقلك الكبد باليمين اذا" هذا يمين مش طريقة مضبوطة لأنو ممكن يكون خِلف خلافه يعني sidus inversus

2°Determine the name of film either chest ,, UTP ...
3° the name of pt and date that was written on X ray
4°look for anatomical extend of film ex urinary system the anatomical landmarks should include last two ribs in upper border till lower end of symphysis pubis
5°prepration of the pt was it good or not ? لما تشوف الأشعة واضحة ومافيش غازات وكل شيء تمام التمام معناه كان التحضير كويس 🙂
Preparation of the patient before contrast x-ray :
1. Renal function test.
to check creatinine level which allow or prevent dyes injection because of its nephrotoxic
effect
some people show abnormal response even if creatinin level was within normal (<1.2) .
2. Laxatives (castor oil).
to clean GIT because urinary system is retroperitoneal so anything inside GIT may prevent clear

6°Quality of the film detected by:
1. Differentiation between bony structures and soft tissues
2. Appearance of soft tissue shadows
" can you see the bones and shadow of organs clearly or not if yes means good film

✨In contrast study we evaluate secretory function of the kidney "perfusion" immediate lightening
of the kidney "good perfusion" .
And an excretory function by notice passage of the dye through the ureter into the bladder to
detect any obstruction .


😍At last your comment"
ex . after proper holding of an X ray ! start to tell the examiner your comment ,,, it is an UTP X ray , for Ali salah , that was taken at 1/11 , well taken involving the anatomical area of urinary tract system"UTS" , with good quality and good preparations as well comment about organs shadow may be there is hepatomegally
and comment of bones if there are any fractures ,, nails,, artificial joints علق على كل حاجة بتشوفها كسور,, مسامير,, عضو متضخم إلخ
Comment if there is any abnormal opacity never ever say there is stone "language of radiology" 🙂 but say there is radio opaque shadow of irregular shap or regular scatterrd or not and size
At last you can say the most probably diagnosis is renal stone 🙂

°conventional X rays either plain or contrast يعني اما صااافي او بصبغة
✨Plain x-rays "without admission of dyes"
KUB (Kidney ureter bladder) old name of urinary x-ray
UTP (urinary tract plain) new name
Aim of plain x-ray is to detect any abnormal opacity
✨Contrast x-rays "with dyes admission"

° when you want to do contrast X ray must do before it non contrast or plain one
°If pt has high level of creatinine the contrast X ray is contra indicated

✨CT give us more anatomical details

✨ before intervention should your pt be free of infection by given him medication before surgery as infection is a risk factor but in some conditions and with some pts could be done even if the infection still persist
" either pt refused waiting for long time or the bacteria in the stone itself


✨ Double J "دعامة"
either diagnostic or therapeutic


✨ وآخر حاجة شرحها الدكتور " فكرة وآلية عمل جهاز التفتيت بالموجات التصادمية"

كيف اقرا X-ray

اول شي بتقول له
1👉Plain x-ray والا digital x-ray
وتذكر ال veiw
اللي ممكن يكون AP أو lateral

مثال
Plain x -ray AP view


2👉personal data
     اسم المريض وتاريخ عمل الأشعة
اذا مش موجود قول
No personal data

مثال

Plain x -ray AP view for pt called حمود الخلقي  Done at 26/10/2022

3👉side &site

Side
يعني Rt والا left وإذا مش عارف أو مش موضح قول unknown side

Site
قول
For pelvis أو thigh أو arm  أو

مثال
Plain x -ray AP view for pt called حمود الخلقي  Done at 26/10/2022 for Rt forearm


4👉 bone
( غالبا بيكون fracture أو ممكن يكون swelling لو كان في tumor أو ممكن cyst أو pus لو كان osteomyelitis )

المهم لو fracture اوصف الآتي
A-site of fracture
مثلا Rt shaft of femur
B-shape
مثلا transverse, oblique أو أي نوع
C- extent
اي ي complete أو incomplete
D-displacement
مثلا lateral أو impacted أو أو


مثال
Plain x -ray AP view for pt called حمود الخلقي  Done at 26/10/2022 for Rt forearm which shows Rt ulnar oblique incomplete angulated fracture

5👉 Cartilage (joint)
وتعلق ب واحدة من الثلاث الكلمات فقط
ي
Normal space
Narrow space
Wide space

مثال

Plain x -ray AP view for pt called حمود الخلقي  Done at 26/10/2022 for Rt forearm which shows Rt ulnar oblique incomplete angulated fracture with normal cartilages space

6👉Soft tissue
وتقول ي
normal
Swelling
Effusion

مثال
Plain x -ray AP view for pt called حمود الخلقي  Done at 26/10/2022 for Rt forearm which shows Rt ulnar oblique incomplete angulated fracture with normal cartilages space and normal soft tissue


وبالتوفيق ي رب 🔥

X. Ray interpretation
د. أنور المغلس

🔻Follow imaging investigation:

  🎯X ray :
   1. preparation
        - pt come on fasting state
        - take laxative ( no air in intestine )
        - centralized [ show  the 11th , 12th ribs + symphysis pubis and below it by 2 cm show urethra ]

  2. For abdomenal pelvic region

📌 plain abdominal-pelvic x ray = Kidney ureter Bladder ( KUB )


🎯X ray with contrast :
     - preceded by plain x ray [ to differentiate between opacity caused by stone and that by the dye ]
     - volume of dye is 1ml to 2ml per kg
     - take film immediately after contrast injection then every five minutes till. reach 20 minutes  after injection     


🚫 Contraindication for contrast :
1. Renal impairment [ abnormal RFT ]
2. Allergy
3. Pregnancy
4. delayed in pt take antihypersensitivity drugs or metformin

📌On prone position the iliac bone appear. on x ray as dog ear.


♦️ When you  look for stones in x ray start from downward upward


🔸Other imaging investigation
🎯Ascending urethrocystography "AUCG"
🎯Descending cystourethrography "DCUG"
🎯Retrograde ureteropyelography "RUPG"
🎯Antegrade pyeloureterograph. "APUG"


📌IVP give an idea about functional capacity of kidney while US give information about morphology of kidney



---------------------------------------

🔅Douple J stent "whole is inside"
🔅Douple J catheter "part of it is out the urethra"



🔸Ureter is divided to three levels
  1. upper ureter from renal pelvis to sacroiliac joint (upper limit)
  2. Middle ureter from sacroiliac joint ( upper limit ) to. lower limit
  3.lower ureter from lower limit of sacroiliac joint to bladder


  

🔸 Causes of obstruction
       - hydronephrosis and its degree by thickness of cortex and parenchyma .
- mass its site and size
- cyst
        usually in adult --> conservative
        in child --> PUJ obstruction diagnosed intrauterine .

- Ureter
- Bladder

       🫧Thickness --> distal obstruction caused by BPH ( diagnosed by PR ,  tumor marker PSA ) , urethral obstruction or diverticulum

      🫧Mass
               -->  may be blood clot that move by movement of pt to one side
               --> middle lobe of prostate



🫧Appearances of pt with CRF is anemic_uremic




♨️congenital anomalie in andrology

    🫧undescended testis associated with malignancy and infertility

    🫧 neurogenic bladder
    🫧 douple bladder
    🫧 ectopic kidney
    🫧 Wilms tumor
    🫧 PUJ obstruction



 📌 Varicocele usually in left side ( left vein drain to IVC ) treated by varicocelectomy.

---------------------------------
📌 patient came with stones in kidney and ureter --> firstly treat that in ureter then that in kidney



📌 patient came with multiple stones in both kidneys start treat the stones that are :  
1. Painful
2.  Hopeful ( one kidney is better than the other ) 
3. Simple( one stone  not like five or six stones)

----------------------------------------

In the case of bone fractures, X-rays are almost a
continuity of the clinical examination. When considering ordering the appropriate views, follow the
‘Rule of twos’.
■ Two views: usually an anterior/posterior view
(AP) and a lateral view.
■ Two joints: include the joint above and the joint
below the bone under consideration.
■ Two sides: useful for comparison, particularly
in children, because it allows comparison of the
epiphyseal lines in immature bones and
distinguishes them from the fracture line.
All X-rays should be centred on the area of maximal tenderness


#جراحة
د/عبدالقادر المنصور

كل ما يتعلق ب x ray يبدأ من هنا

https://t.me/Surgery_Lab_37B/32
ملخصات الدكتور محمد علي صالح
https://t.me/Surgery_Lab_37B/29
ملخصات الدكتور محمد الدوبلي للدفع السابقة تبدأ من هنا
https://t.me/Surgery_Lab_37B/149

#Sutures الخيوط الجراحية

*Types :
▪️According to absorbance :
I- Absorbable sutures:
A. Natural (e. g Catgut ) .
B. Synthetic( e. g Polyglycolic acid, PDS, Polyglactin, monocryl polyglecapron 25).
II- Non-absorbable sutures:
A. Natural (e. g silk )
B. Synthetic( e. g Nylon, Prolene, PTFE, stabler, adhesive tapes ,stainless-steel)

▪️According to filaments :
A- monofilament sutures
B- multifilament sutures

Buerger's disease: Features

"burger SCRAPS":

•Segmenting thrombosing vasculitis
•Claudication (intermittent)
•Raynaud's phenomenon
•Associated with smoking
•Pain, even at rest
•Superficial nodular phlebitis

Why the appendicitis is dangerous?
For these reasons:
1⃣-the appendix is closed at one end , so can be easily blocked.
2⃣ the appendicular artery is an end-artery , so gangrene can occur fast.
3⃣ the appendix has thin muscular coat, so perforates easily.
4⃣the lumen of the appendix is very narrow.

Symptoms of acute lower limb ischemia:
( 5P)⏬
Pain
Pallor
paresis
pulselessness
Paraesthesia

Signs of acute lower limb ischemia:
( 7P)⏬
Peripheries are cold
Pallor of the limb
Poor capillary return
Positive Buerger's test
Progressive paralysis
Pulses are absent
Pulse at ankle by doppler is undetectable

🟣Rule of 2 for Meckel's diverticulum🟣:

☑️Incidence: 2%
☑️Location: 2 feet proximal to ICJ
☑️Length: 2 inches long
☑️Presentation: 2 years or below 2 years is the most common age.
☑️Ectopic tissue: 2 types_ gastric & pancreatic.
☑️Male: female ratio 1:2