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



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🔅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.

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📌 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)

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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