🔻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

عمليات

✔️ Herniorrhaphy : by suture or
stitch

✔️ Hernioplasty : by mesh (Tension-free repair)

✔️ herniotomy : commonly associated with congenital indirect hernias , open sac , reduce contents , ligate

✔️ Herniorrhaphy : by suture or stitch مش ضروري نفتحو sac

✔️ Hernioplasty : by mesh (Tension-free repair)

✔️ herniotomy : commonly associated with congenital indirect hernias , open sac , reduce contents , ligate no suture or mesh

✔️ shouldice repair : four-layer inguinal hernia repair by sutures
( best one in emergency and can used elective ) + recuts release

✔️ Bassini repair : suturing the transversalis fascia and the conjoined tendon to the inguinal ligament ( old )


✔️ Lichtenstein repair : best one in inguinal hernia by mesh


✔️ Mc-evedy repair : best one in femoral hernia ( high approach )

✔️ lookwood : low approach for femoral hernia from thigh

✔️ Lotheissen’s : inguinal approach for femoral hernia

DDx of Pain according site in abdomen

دِ علي محمد صالح
د عبداللطيف

NAME of incision in abdominal operation
د عبداللطيف ابو طالب

differential diagnosis of a mass in the right iliac fossa are:
♕Appendix mass
♕Appendix abscess
♕Tuberculosis
♕Carcinoma of caecum
♕Crohn’s disease (terminal ileitis)
♕Iliac lymphadenopathy
♕Iliac artery aneurysm
♕Psoas abscess
♕Chondrosarcoma or osteosarcoma of
the ilium
♕Tumour in an undescended testis
♕Actinomycosis
♕Ruptured epigastric artery
♕Spigelian hernia
♕Kidney transplant
♕Ovarian cyst/tumour
♕Fibroid
♕Malignant change in an undescended testis

سؤال مشهور في الجراحة:

The causes of abdominal swelling :-

🛑 9 - F 🛑

1- Fat
2- Feces
3- Fluid
4- Flatus
5- Fetus
6- False pregnancy
7- Fibroids
8- Full bladder
9- Full _sized tumer

https://t.me/Group_C_5_Clinical_Thirty_Seven

مستشفى الكويت د.نبيل عثمان
---------------------------------------

1-History مابيركز عليها كثير
2-examination بيركز عليها
بدأ بمريضه gall bladder stone
من الاشياء الي ركز عليها
Inspiction (scar)
Palpation ايش نستفيد منها ،او ايش نحس
وقال ضروري تحفظ exam لكل عضو او مرض
3-types of TB
Intestine
(Ulceration المناعه ضعيفه
,Hypertrophy تكون المناعه قويه )
Peritoneal  (adhesion )
4-cuase of intestinal obstruction
Stone
Adhesion
Hernia
Worm
Volvulus
Strangulation

5-سأل هل نعمل العمليه مباشره اذا حدث obstruction ?
لاننتظر48 ساعه (نبدأ نسحب السوائل ،نشوف لو اتحسن
6-impact stool
وذكر management منها نعمل colostomy وبعدها عمليه
6-في حالة hernia ركز على
-types of hernia
-site of hernia
-كيف نفرق بين
direct and indirect hernia
-كيف نفرق بين
int.and ext.abd.mass
يعمل المريض contraction ونشوف لو الmass بقي نفس ماهو int.
-كيف نعرف الhernia او ايش العلامات المميزه
-impulse on cough
-reducibility
-in anatomical site

7-cuases of pain in chest
من الي ذكرها امراض الرئه
8-مراحل الempyema
9-indication of chest tube
10-type of fracture in bone
Linear
Segmental
Flail chest(متى يحدث؟,ايش علاجه )
علاجه rest ,analgesic ventilation
11-peumothorax
متى ندخل او الحاله تستدعي ؟اذا كان اكثر من 25%
12-tension pneumothorax
كيف نشخصه ؟وايش علاجه ؟
اهم شيء absent sound
وفي العلاج
needle in 2intercostal space *
13-hemothorax متى ندخل جراحيا
اذا خرج >1000 ccدم
14-cardiac temponade
كيف نشخصه ?وكيف نعالجه
اهم شيء ذكره EChO
وفي العلاج paracardialcentesis
15-large vessle injury
كيف نعرف ان حصل injury?
Hemothorxac
16-oesophagus injury ؟
يحصل opacity of lung
17-large bronchus injury ?
يكون الهواء الخارج في chest tube قوي
18-diaphragm injury ?
تطلعabd.content للchest
العمليه تكونemergency
19-فين مكان chest tube بالجسم ؟
Safe triangle
ايش حدودها؟
20- لو في انفجار قريب منك ايش بيحصل؟( ننبطح 😄 هذا جواب طالب )
-shock wave
-shock wind (بيحصل
injury لكل الاعضاء المتأثره )


💢 تجميعات وملخصات الدفع السابقة لمحاضرات
الدكتور الفاضل نبيل عثمان ..✨

💢 Appendicitis Inflammatory Response Score 
for management of acute appendicitis ... Findings: 

♕Vomiting=1
♕Pain in the right inferior fossa=1
♕Rebound tenderness 
Light=1
Medium=2
Strong=3
♕Body temperature ≥38.5°C=1
♕Polymorphonuclear leukocytes
70%–84%=1
≥85%=2
♕White blood cell count
10.0–14.9 × 109cells/L=1
≥15.0 × 109 cell/L =2
♕C-reactive protein concentration
10–49 g/L=1
≥50 g/L =2


- Score :-

♕: 0–4: Low probability. Outpatient follow-up.
♕5–8: Indeterminate group. Active observation or diagnostic laparoscopy.
♕9–12: High probability. Surgical exploration

🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻🔻

💢 Alvarado Score  for diagnosis of acute appendicitis ... Findings :-

♕Migratory right iliac fossa pain=1
♕Anorexia=1
♕Nausea or vomiting=1
♕Tenderness: right iliac fossa=2
♕Rebound tenderness right iliac fossa=1
♕Fever ≥36.3°C=1
♕Leukocytosis ≥10 × 109
cells/L=2
♕Shift to the left of neutrophils =1


Score:

♕ <3: Low likelihood of appendicitis
♕4–6: Consider further imaging
♕≥7: High likelihood of appendicitis


د/نبيل عثمان
#جراحة#

💢 تجميعات وملخصات الدفع السابقة لمحاضرات
الدكتور الفاضل نبيل عثمان ..✨

Triad of death in surgical room.