🔷Mx Of Diabetic Foot
📍1. Patient Education (Grade 0) :
▪︎No Bare Walking لا تمشي حافي
▪︎No Corn Or Callus Removal
▪︎Attention To Hot Water
▪︎Use Creams For Foot Moisture
▪︎Wear Comfort Shoes
▪︎Stop Alcohol & Smoking
▪︎Glycemic Control
📍2. Reduce Mechanical Factors (Grade I) By Using :
▪︎Walking Aids
▪︎Medical Shoes
▪︎Walking Plaster Casts
▪︎Correction Of Foot Or Bony Deformities
📍3. Reduce Metabolic Factors (For All Grades Mx Of Hypertension/Hyperglycemia/HyperLipidemia/Anemia/Vitamins Deficiency)
📍4. Wound Control (Grade ≥2) :
🔻I. Culture & Sensitivity & Antibiotics (3w For Subcutaneous Infection & 12w For OsteoMyelitis)
🔻II. Foot Xray (To Detect Gas in Deep Tissue/Foreign Body/Bony Erosions/Joint Deformity)
🔻III. Wound Care :
▪︎Necrotic Tissue Debridement
▪︎Daily Dressing & Cleaning
▪︎Hyperbaric Oxygen Therapy
▪︎Platelet Derived Growth Factors
▪︎Skin Graft Or Flap To Close Defect
▪︎Infected Bone Excision (Grade III)
📍5. Amputation :
🔻I. Indications For Amputation :
▪︎Grade 4-5 Diabetic Foot
▪︎Severe Infection (Deep Tissue Necrotizing Infection/Deep Abscess/Uncontrolled Sepsis)
▪︎Tissue Gangrene
▪︎Non-Ambulatory Patient المريض اصلا مقعد
▪︎Inability To Obtain Planter Grade For Weight Bearing
يعني القدم منتهية صلاحيتها وماعاد يقدر يمشي عليها
🔻II. Types Of Amputation :
▪︎Partial Foot Amputation
▪︎Below Knee Amputation
▪︎Above Knee Amputation
#Diabetic_Foot_ulcer
#Surgery_rotation
https://t.me/Surgery_Practice
📍1. Patient Education (Grade 0) :
▪︎No Bare Walking لا تمشي حافي
▪︎No Corn Or Callus Removal
▪︎Attention To Hot Water
▪︎Use Creams For Foot Moisture
▪︎Wear Comfort Shoes
▪︎Stop Alcohol & Smoking
▪︎Glycemic Control
📍2. Reduce Mechanical Factors (Grade I) By Using :
▪︎Walking Aids
▪︎Medical Shoes
▪︎Walking Plaster Casts
▪︎Correction Of Foot Or Bony Deformities
📍3. Reduce Metabolic Factors (For All Grades Mx Of Hypertension/Hyperglycemia/HyperLipidemia/Anemia/Vitamins Deficiency)
📍4. Wound Control (Grade ≥2) :
🔻I. Culture & Sensitivity & Antibiotics (3w For Subcutaneous Infection & 12w For OsteoMyelitis)
🔻II. Foot Xray (To Detect Gas in Deep Tissue/Foreign Body/Bony Erosions/Joint Deformity)
🔻III. Wound Care :
▪︎Necrotic Tissue Debridement
▪︎Daily Dressing & Cleaning
▪︎Hyperbaric Oxygen Therapy
▪︎Platelet Derived Growth Factors
▪︎Skin Graft Or Flap To Close Defect
▪︎Infected Bone Excision (Grade III)
📍5. Amputation :
🔻I. Indications For Amputation :
▪︎Grade 4-5 Diabetic Foot
▪︎Severe Infection (Deep Tissue Necrotizing Infection/Deep Abscess/Uncontrolled Sepsis)
▪︎Tissue Gangrene
▪︎Non-Ambulatory Patient المريض اصلا مقعد
▪︎Inability To Obtain Planter Grade For Weight Bearing
يعني القدم منتهية صلاحيتها وماعاد يقدر يمشي عليها
🔻II. Types Of Amputation :
▪︎Partial Foot Amputation
▪︎Below Knee Amputation
▪︎Above Knee Amputation
#Diabetic_Foot_ulcer
#Surgery_rotation
https://t.me/Surgery_Practice
❤2
❇️ The stoma
▪︎is an artificial opening made in the colon or small intestine to divert faeces and flatus out-side the abdomen where they can be collected in an external Bag.
▪︎stoma may be temporary or permanent / End or loop
▪︎Colostomy: from the large bowel.
▪︎Ileostomy: from the small bowel.
🔹Indications of stoma (p1)
▪︎Permanent end-colostomy: abdominoperineal resection of large rectal cancers leading to the removal of the entire rectum.
▪︎Temporary end-colostomy: allow the distal bowel to rest in the Cases of acute diverticulitis or obstruction.
▪︎Temporary Loop colostomy: protect distal anastomoses after recent surgery.
#Stoma
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎is an artificial opening made in the colon or small intestine to divert faeces and flatus out-side the abdomen where they can be collected in an external Bag.
▪︎stoma may be temporary or permanent / End or loop
▪︎Colostomy: from the large bowel.
▪︎Ileostomy: from the small bowel.
🔹Indications of stoma (p1)
▪︎Permanent end-colostomy: abdominoperineal resection of large rectal cancers leading to the removal of the entire rectum.
▪︎Temporary end-colostomy: allow the distal bowel to rest in the Cases of acute diverticulitis or obstruction.
▪︎Temporary Loop colostomy: protect distal anastomoses after recent surgery.
#Stoma
#Surgery_rotation
https://t.me/Surgery_Practice
■❇️Stoma Types & Complications
🔹Indications of stoma (P2)
▪︎Permanent End ileostomy: after a panproctocolectomy (rectum & colon removal) for conditions such as ulcerative colitis or familial adenomatous polyposis.
▪︎Temporary End-ileostomy: during emergency bowel resection where it is considered unsafe to form an anastomosis with the remaining bowel at that time (e.g. intra-abdominal sepsis or bleeding).
▪︎Temporary loop ileostomy: protect distal anastomoses after recent surgery.
🔹Comparison
●Ileostomy:
•Spout Present (عنق)
•Fluid content
•In right iliac fossa
•Develop fluid & Electrolyte imbalance
●Colostomy:
•No Spout
•Solid content
•In left iliac fossa
#Stoma
#Surgery_rotation
https://t.me/Surgery_Practice
🔹Indications of stoma (P2)
▪︎Permanent End ileostomy: after a panproctocolectomy (rectum & colon removal) for conditions such as ulcerative colitis or familial adenomatous polyposis.
▪︎Temporary End-ileostomy: during emergency bowel resection where it is considered unsafe to form an anastomosis with the remaining bowel at that time (e.g. intra-abdominal sepsis or bleeding).
▪︎Temporary loop ileostomy: protect distal anastomoses after recent surgery.
🔹Comparison
●Ileostomy:
•Spout Present (عنق)
•Fluid content
•In right iliac fossa
•Develop fluid & Electrolyte imbalance
●Colostomy:
•No Spout
•Solid content
•In left iliac fossa
#Stoma
#Surgery_rotation
https://t.me/Surgery_Practice
👍2
Stoma Examination ■
▪︎Begin by inspecting the stoma
noting :
●The site (Right/Left Iliac fossa)
●the number of lumens (1 End/2 Loop)
●the presence or absence of a spout (Neck)
●the contents of the effluent (Solid/Fluid)
▪︎Inspect the surrounding skin for erythema, tissue breakdown، Hernia, fistulation
▪︎Spout present: ileostomy
(مخرج الستومة مرتفع عن الجلد زي العنق )
▪︎Spout absent: colostomy
(مخرج الستومة مع الجلد مافيش عنق)
#Stoma
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎Begin by inspecting the stoma
noting :
●The site (Right/Left Iliac fossa)
●the number of lumens (1 End/2 Loop)
●the presence or absence of a spout (Neck)
●the contents of the effluent (Solid/Fluid)
▪︎Inspect the surrounding skin for erythema, tissue breakdown، Hernia, fistulation
▪︎Spout present: ileostomy
(مخرج الستومة مرتفع عن الجلد زي العنق )
▪︎Spout absent: colostomy
(مخرج الستومة مع الجلد مافيش عنق)
#Stoma
#Surgery_rotation
https://t.me/Surgery_Practice
🔴Scrotal swelling
🔹Painful
▪︎Testicular torsion
▪︎incarcerated Inguinal hernia
▪︎Epididym orchitis
▪︎Torsion of appendix testis (Blue Dots Sign)
▪︎Truma
🔹Painless
▪︎Hydrocele
▪︎Spermatocele
▪︎Varicocele
▪︎Reducible Inguinal hernia
▪︎Testicular tumor
🔹Emergent
▪︎testicular torsion
▪︎Necrotizing fasciitis (Fournier’s gangrene)
▪︎Trauma
▪︎Epididym orchitis
▪︎Mostly In Left Side ➡️ Varicocele
▪︎Mostly in Right Side ➡️ Undescended Testis/Testicular Tumor/Inguinal Hernia
▪︎+Ve Transillumination
•Hydrocele ➡️ Testis Not Palpable
•Spermatocele ➡️ Testis Are Palpable
▪︎Scrotal Elevation Relief The Pain (+Ve Prehn's Sign) ➡️ Epididmyitis/Orchitis
▪︎Scrotal Elevation Not Relief The Pain (-Ve Prehn's Sign) ➡️ Testicular Torsion
▪︎-Ve (Absent) Cremasteric Reflex ➡️ Testicular Torsion
#Surgery_rotation
https://t.me/Surgery_Practice
🔹Painful
▪︎Testicular torsion
▪︎incarcerated Inguinal hernia
▪︎Epididym orchitis
▪︎Torsion of appendix testis (Blue Dots Sign)
▪︎Truma
🔹Painless
▪︎Hydrocele
▪︎Spermatocele
▪︎Varicocele
▪︎Reducible Inguinal hernia
▪︎Testicular tumor
🔹Emergent
▪︎testicular torsion
▪︎Necrotizing fasciitis (Fournier’s gangrene)
▪︎Trauma
▪︎Epididym orchitis
▪︎Mostly In Left Side ➡️ Varicocele
▪︎Mostly in Right Side ➡️ Undescended Testis/Testicular Tumor/Inguinal Hernia
▪︎+Ve Transillumination
•Hydrocele ➡️ Testis Not Palpable
•Spermatocele ➡️ Testis Are Palpable
▪︎Scrotal Elevation Relief The Pain (+Ve Prehn's Sign) ➡️ Epididmyitis/Orchitis
▪︎Scrotal Elevation Not Relief The Pain (-Ve Prehn's Sign) ➡️ Testicular Torsion
▪︎-Ve (Absent) Cremasteric Reflex ➡️ Testicular Torsion
#Surgery_rotation
https://t.me/Surgery_Practice
🔴Hydrocele
▪︎Abnormal Serous Fluid collection in the Scrotum
🔹Causes
▪︎Primary (Congenital-Communicating)
•Infantile
•Congenital
•Encysted
•Vaginal
▪︎Secondary (Non Communicating)
•Truma/Tumor
•EpididymoOrchitis
•Lymphatic Obstruction
•After Varicocelectomy
🔹Tx
▪︎In Children
•May Resolve in 1st 2 Years of life
•Herniotomy
▪︎In Adults : Surgical Excision
🔴Undescended Testis
🔹Most Common Sites For Testis
•External Inguinal Ring
•Inguinal Canal
•Abdomen (Testis Not Palpable)
🔹Complications
•Infertility (More in Intra abdominal Testis)
•Pain (By Truma or Torsion)
•Epidymorchitis
•Cancer
•Indirect Inguinal Hernia
🔹Tx
1. Palpable
▪︎Orchidopexy (moves undescended Testis into the scrotum & Fixation)
▪︎Orchidolysis (correction of the undescended Testis without fixation)
2. Non Palpable
▪︎Inguinal Surgical Exploration
▪︎Laparoscopy
🔰Time of Correction Of
▪︎Hernia ➡️ Within 1 Month
▪︎Undescended Testis ➡️ Within 1 Year
▪︎Hydrocele ➡️ Within 2 Years
https://t.me/Surgery_Practice
▪︎Abnormal Serous Fluid collection in the Scrotum
🔹Causes
▪︎Primary (Congenital-Communicating)
•Infantile
•Congenital
•Encysted
•Vaginal
▪︎Secondary (Non Communicating)
•Truma/Tumor
•EpididymoOrchitis
•Lymphatic Obstruction
•After Varicocelectomy
🔹Tx
▪︎In Children
•May Resolve in 1st 2 Years of life
•Herniotomy
▪︎In Adults : Surgical Excision
🔴Undescended Testis
🔹Most Common Sites For Testis
•External Inguinal Ring
•Inguinal Canal
•Abdomen (Testis Not Palpable)
🔹Complications
•Infertility (More in Intra abdominal Testis)
•Pain (By Truma or Torsion)
•Epidymorchitis
•Cancer
•Indirect Inguinal Hernia
🔹Tx
1. Palpable
▪︎Orchidopexy (moves undescended Testis into the scrotum & Fixation)
▪︎Orchidolysis (correction of the undescended Testis without fixation)
2. Non Palpable
▪︎Inguinal Surgical Exploration
▪︎Laparoscopy
🔰Time of Correction Of
▪︎Hernia ➡️ Within 1 Month
▪︎Undescended Testis ➡️ Within 1 Year
▪︎Hydrocele ➡️ Within 2 Years
https://t.me/Surgery_Practice
🔴Varicocele
▪︎abnormal enlargement and Tortuous of the pampiniform venous plexus in the scrotum
🔹Features
1.More in Left Side (Higher & More perpendicular Course of Left Testicular Vein)
2.Painless
3.Palpation feels like bag of Warms
4.Pulsates with Valsalva (Increase Intra abdominal pressure)
5.Cause Infertility (Due to High Scrotal Temperature)
6.Cause Testicular Atrophy
7.Affected Side Will be Lower than Normal
🔹Aetiology
1.Incompetent Venous Valves (Congenital)
2.Prolong Standing
3.Chronic Increase in Intra Abdominal Pressure (Like Chronic Pulmonary Disease)
4.Nut Cracker Phenomenon (Left Renal V entrapment Between Aorta & Superior Mesenteric A)
🔹Dx ➡️ Doppler US
🔹Tx
▪︎Varicocelectomy (Ligation Or Occlusion of Internal Spermatic Veins)
▪︎Indications Of Tx
1.Infertility (Impaired Sperm Quality Or Quantity)
2.Pain
3.Testis Fail to Grow
▪︎Complications of Tx
1.Recurrence
2.Hydrocele
3.Testicular Infarction (Injury of Testicular A)
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎abnormal enlargement and Tortuous of the pampiniform venous plexus in the scrotum
🔹Features
1.More in Left Side (Higher & More perpendicular Course of Left Testicular Vein)
2.Painless
3.Palpation feels like bag of Warms
4.Pulsates with Valsalva (Increase Intra abdominal pressure)
5.Cause Infertility (Due to High Scrotal Temperature)
6.Cause Testicular Atrophy
7.Affected Side Will be Lower than Normal
🔹Aetiology
1.Incompetent Venous Valves (Congenital)
2.Prolong Standing
3.Chronic Increase in Intra Abdominal Pressure (Like Chronic Pulmonary Disease)
4.Nut Cracker Phenomenon (Left Renal V entrapment Between Aorta & Superior Mesenteric A)
🔹Dx ➡️ Doppler US
🔹Tx
▪︎Varicocelectomy (Ligation Or Occlusion of Internal Spermatic Veins)
▪︎Indications Of Tx
1.Infertility (Impaired Sperm Quality Or Quantity)
2.Pain
3.Testis Fail to Grow
▪︎Complications of Tx
1.Recurrence
2.Hydrocele
3.Testicular Infarction (Injury of Testicular A)
#Surgery_rotation
https://t.me/Surgery_Practice
🔰Foley Catheter
🔹1-Way urinary catheters
▪︎have only one channel for passage of urine.
Like CIC (clean intermittent catheterization)
🔹2-Way urinary catheters
▪︎The most Commonly Used
▪︎Have two channels: one channel is for the passage of urine and the other for balloon inflation and deflation.
🔹3-Way urinary catheters
▪︎available with a third channel to facilitate continuous bladder irrigation
▪︎primarily used After urological surgery or in case of bleeding from a bladder or prostate, For continuous or intermittent irrigation to clear blood clots or debris.
🔹Duration
▪︎7-10 days for latex
▪︎1 month for the silicon
🔹Alternative way
▪︎suprapubic cystostomy
▪︎Catheter Length 40-45 cm
▪︎Recommended Use The Smallest Size
▪︎Most Common Materials ➡️ Silicon/Silicon Coated Latex
▪︎Size Measurement By French (1FR=3mm)
#Surgery_rotation
https://t.me/Surgery_Practice
🔹1-Way urinary catheters
▪︎have only one channel for passage of urine.
Like CIC (clean intermittent catheterization)
🔹2-Way urinary catheters
▪︎The most Commonly Used
▪︎Have two channels: one channel is for the passage of urine and the other for balloon inflation and deflation.
🔹3-Way urinary catheters
▪︎available with a third channel to facilitate continuous bladder irrigation
▪︎primarily used After urological surgery or in case of bleeding from a bladder or prostate, For continuous or intermittent irrigation to clear blood clots or debris.
🔹Duration
▪︎7-10 days for latex
▪︎1 month for the silicon
🔹Alternative way
▪︎suprapubic cystostomy
▪︎Catheter Length 40-45 cm
▪︎Recommended Use The Smallest Size
▪︎Most Common Materials ➡️ Silicon/Silicon Coated Latex
▪︎Size Measurement By French (1FR=3mm)
#Surgery_rotation
https://t.me/Surgery_Practice
🔰Foley Catheter
🔹indications of use :
▪︎one way :-
-in CIC (clean intermittent catheterization)
▪︎two way :-
○Diagnostic :
•Urine collection (measurements Of Urine Output & residual volume)
○therapeutic :
•Relive Acute urinary retention
•During Urologic & Contiguous Surgery (To Prevent Urine leakage by accident)
▪︎three way :-
•Bladder Irrigation After Bleeding (Clots Present)
•injection Of AB & Chemotherapy & Contrast
•Urodynamic and Cystography
🔹Long Term Catheterization For
1. Refractory urine retention (not correctable)
2. Neurogenic bladder
3. Incontinence
🔹Contraindications
1. Suspected Urethral injury
2. Urethral Strictures
3. Urethral Sepsis
4. High Riding Or Detached Prostate
5. Difficult Insertion For Other Reasons
🔹Complications
1. Inability to catheterize
2. Infection
3. Urethral injury/Stricture
4. Psychological trauma
5. Paraphimosis
6. Hematuria
7. Stone Formation
8. Allergy or sensitivity to latex
9. Bladder cancer (After long-term Use)
https://t.me/Surgery_Practice
🔹indications of use :
▪︎one way :-
-in CIC (clean intermittent catheterization)
▪︎two way :-
○Diagnostic :
•Urine collection (measurements Of Urine Output & residual volume)
○therapeutic :
•Relive Acute urinary retention
•During Urologic & Contiguous Surgery (To Prevent Urine leakage by accident)
▪︎three way :-
•Bladder Irrigation After Bleeding (Clots Present)
•injection Of AB & Chemotherapy & Contrast
•Urodynamic and Cystography
🔹Long Term Catheterization For
1. Refractory urine retention (not correctable)
2. Neurogenic bladder
3. Incontinence
🔹Contraindications
1. Suspected Urethral injury
2. Urethral Strictures
3. Urethral Sepsis
4. High Riding Or Detached Prostate
5. Difficult Insertion For Other Reasons
🔹Complications
1. Inability to catheterize
2. Infection
3. Urethral injury/Stricture
4. Psychological trauma
5. Paraphimosis
6. Hematuria
7. Stone Formation
8. Allergy or sensitivity to latex
9. Bladder cancer (After long-term Use)
https://t.me/Surgery_Practice
🔴Testicular Torsion
▪︎Posterior High Insertion Of Tunica Vaginalis (Bilateral) ➡️ Testis Freely Mobile Inside The Scrotum (Bell Clapper Deformity) ➡️ Torsion
▪︎Two Peaks ➡️ 1st Year Of Life/At Puberty
▪︎High Risk Factor ➡️ Undescended Testis
▪︎Torsion <6h ➡️ Testis Can Be Saved
🔹Presentation
1. Hx Of pain Resolved Spontaneously (At Exertion/Sport/Truma/Cold Weather/Sleep)
2. Sudden Severe Scrotal Pain
3. Nausea & Vomiting
4. Swollen Tender Firm Hemiscrotum
5. High Riding Testis (Transverse Lie)
6. Loss Of Cremasteric Reflex
🔹Confirm Dx ➡️ Doppler US (Decrease Blood Flow)
🔹Types Of Torsion
1. IntraVaginal (Within Tunica Vaginalis) ➡️ At Puberty
2. ExtraVaginal (Along The Tunica Vaginalis) ➡️ In 1st year Of Life
🔹Tx
A. Viable
1. Detorsion (Medial To Lateral Open Book)
2. Orchiopexy Of Both Testis
B. Not Viable ➡️ Orchiectomy
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎Posterior High Insertion Of Tunica Vaginalis (Bilateral) ➡️ Testis Freely Mobile Inside The Scrotum (Bell Clapper Deformity) ➡️ Torsion
▪︎Two Peaks ➡️ 1st Year Of Life/At Puberty
▪︎High Risk Factor ➡️ Undescended Testis
▪︎Torsion <6h ➡️ Testis Can Be Saved
🔹Presentation
1. Hx Of pain Resolved Spontaneously (At Exertion/Sport/Truma/Cold Weather/Sleep)
2. Sudden Severe Scrotal Pain
3. Nausea & Vomiting
4. Swollen Tender Firm Hemiscrotum
5. High Riding Testis (Transverse Lie)
6. Loss Of Cremasteric Reflex
🔹Confirm Dx ➡️ Doppler US (Decrease Blood Flow)
🔹Types Of Torsion
1. IntraVaginal (Within Tunica Vaginalis) ➡️ At Puberty
2. ExtraVaginal (Along The Tunica Vaginalis) ➡️ In 1st year Of Life
🔹Tx
A. Viable
1. Detorsion (Medial To Lateral Open Book)
2. Orchiopexy Of Both Testis
B. Not Viable ➡️ Orchiectomy
#Surgery_rotation
https://t.me/Surgery_Practice
🔴 Necrotising fasciitis
♦️infection that spreads quickly along the fascial plane ➡️ necrosis of the SC tissues & overlying skin.
غالبا تسببها b-haemolytic streptococci او staph aureus وممكن polymicrobial
💠 types:
و فيها 4 انواع (حسب دافيدسون):
▪️Type 1 : polymicrobial
ونشوفها بعد العمليات عند immunocompromised&DM
▪️Type 2 : :group A or other streptococci (60% of cases are associated with streptococcal toxic shock syndrome)
▪️Type 3: Aeromonas hydrophila and Vibrio vulnificus
▪️Type 4 : fungi ( as mucoraceous moulds)
▫️مدسكيب معتبر النوع الثالث هو
Type III gas gangrene or Clostridium myonecrosis
♦️يطلقون عليها اسماء خاصة اذا صارت بمناطق معينة :
▫️Abdominal wall : Meleney’s synergistic hospital gangrene
Scrotal infection : Fournier’s gangren
♦️60% in the lower extremities.
Predisposing conditions include:
▪️diabetes;
▪️smoking;
▪️ penetrating trauma;
▪️pressure sores;
▪️ immunocompromised states;
▪️ intravenous drug abuse;
▪️perineal infection (perianal abscess, Bartholin’s cysts);
▪️skin damage/infection (abrasions, bites, boils).
▪️In liver cirrhosis
▪️NSAIDS use ( associated with type II necrotizing fasciitis)
▪️Colon cancer or leukaemia
♦️pathology:
بشكل مختصر :
inflammatory infiltrate, extensive necrosis, oedema and thrombosis of the microvasculature.
♦️ presentation:
كيف يجي المريض ؟
عادة مريض متعرض ل trauma او مسوي عملية او any invasive procedure
ع الاغلب عنده امراض مزمنة مثلا سكر او PAD
يشكو من :
▪️intense pain and tenderness over the involved skin and underlying muscle. Over next several hours to days, progresses to anaesthesia
Occurs before fever, malaise, and myalgias.
▪️cutaneous erythema and oedema that extending beyond the area of erythema, skin vesicles, and crepitus
▪️skin turns dusky blue and black (due to thrombosis & necrosis)
▪️area develop bullae & overt cutaneous gangrene with SC emphysema
▪️SC tissue demonstrates a wooden, hardened feel
▪️fascial planes and muscle groups cannot be detected by palpation
▪️produces skip lesions that later coalesce.
♦️Unlike in cellulitis:
-pain disproportionately intense in relation to the visible cutaneous features or may spread beyond the zone of erythema.
-absent of Lymphangitis
▪️كذلك fever &tachycardia و مرات يوصل لل
severe toxicity , septic shock& renal failure
♦️DDx:
Acute epididymitis
Cellulitis
Orchitis
Testicular torsion
Toxic shock syndrome
♦️Ix:
كيف يتشخص :
CBC,biochemistry
معاها:
ABG , blood and tissue cultures (deeper tissue samples not from skin or SC tissue)
⬆️⬆️ Creatinine kinase
Radiographs : air in the tissues.
doppler, CT,MRI
Tissue fluid aspiration and analysis
*the following may be associated with necrotizing fasciitis:
⬆️WBC count)> 14,000/µL
⬆️BUN level > 15 mg/mL
⬇️ serum sodium level < 135 mmol/L
♦️Rx:
العلاج
▪️: اول شي ندخله ICU
-Supportive ( fluid, O2 )
احيانا يحتاجوا endotracheal intubation
-Abx: IV penicillin G + ceftriaxone & flagyl
و نحضرله دم لان العملية ⬇️ تسبب profuse bleeding-
و الخطوة الاساسية بالعلاج هي : -
surgical excision+- skin graft
بعدها نخلي شاش و نغطي الجرح dressing esp. vacuum-assisted dressings.
و يوميه ننظفه و نغطيه
في كمان option اللي هو :
hyperbaric oxygen (HBO) in high-pressure chamber
(improves neutrophil function & promotes wound healing)
نخلي المرضى ب high-pressure chamber
و نعطي 100% O2
بضغط
2-3 atm
#Necrotising fasciitis
#Davidson
#Surgery_rotation
https://t.me/Surgery_Practice
♦️infection that spreads quickly along the fascial plane ➡️ necrosis of the SC tissues & overlying skin.
غالبا تسببها b-haemolytic streptococci او staph aureus وممكن polymicrobial
💠 types:
و فيها 4 انواع (حسب دافيدسون):
▪️Type 1 : polymicrobial
ونشوفها بعد العمليات عند immunocompromised&DM
▪️Type 2 : :group A or other streptococci (60% of cases are associated with streptococcal toxic shock syndrome)
▪️Type 3: Aeromonas hydrophila and Vibrio vulnificus
▪️Type 4 : fungi ( as mucoraceous moulds)
▫️مدسكيب معتبر النوع الثالث هو
Type III gas gangrene or Clostridium myonecrosis
♦️يطلقون عليها اسماء خاصة اذا صارت بمناطق معينة :
▫️Abdominal wall : Meleney’s synergistic hospital gangrene
Scrotal infection : Fournier’s gangren
♦️60% in the lower extremities.
Predisposing conditions include:
▪️diabetes;
▪️smoking;
▪️ penetrating trauma;
▪️pressure sores;
▪️ immunocompromised states;
▪️ intravenous drug abuse;
▪️perineal infection (perianal abscess, Bartholin’s cysts);
▪️skin damage/infection (abrasions, bites, boils).
▪️In liver cirrhosis
▪️NSAIDS use ( associated with type II necrotizing fasciitis)
▪️Colon cancer or leukaemia
♦️pathology:
بشكل مختصر :
inflammatory infiltrate, extensive necrosis, oedema and thrombosis of the microvasculature.
♦️ presentation:
كيف يجي المريض ؟
عادة مريض متعرض ل trauma او مسوي عملية او any invasive procedure
ع الاغلب عنده امراض مزمنة مثلا سكر او PAD
يشكو من :
▪️intense pain and tenderness over the involved skin and underlying muscle. Over next several hours to days, progresses to anaesthesia
Occurs before fever, malaise, and myalgias.
▪️cutaneous erythema and oedema that extending beyond the area of erythema, skin vesicles, and crepitus
▪️skin turns dusky blue and black (due to thrombosis & necrosis)
▪️area develop bullae & overt cutaneous gangrene with SC emphysema
▪️SC tissue demonstrates a wooden, hardened feel
▪️fascial planes and muscle groups cannot be detected by palpation
▪️produces skip lesions that later coalesce.
♦️Unlike in cellulitis:
-pain disproportionately intense in relation to the visible cutaneous features or may spread beyond the zone of erythema.
-absent of Lymphangitis
▪️كذلك fever &tachycardia و مرات يوصل لل
severe toxicity , septic shock& renal failure
♦️DDx:
Acute epididymitis
Cellulitis
Orchitis
Testicular torsion
Toxic shock syndrome
♦️Ix:
كيف يتشخص :
CBC,biochemistry
معاها:
ABG , blood and tissue cultures (deeper tissue samples not from skin or SC tissue)
⬆️⬆️ Creatinine kinase
Radiographs : air in the tissues.
doppler, CT,MRI
Tissue fluid aspiration and analysis
*the following may be associated with necrotizing fasciitis:
⬆️WBC count)> 14,000/µL
⬆️BUN level > 15 mg/mL
⬇️ serum sodium level < 135 mmol/L
♦️Rx:
العلاج
▪️: اول شي ندخله ICU
-Supportive ( fluid, O2 )
احيانا يحتاجوا endotracheal intubation
-Abx: IV penicillin G + ceftriaxone & flagyl
و نحضرله دم لان العملية ⬇️ تسبب profuse bleeding-
و الخطوة الاساسية بالعلاج هي : -
surgical excision+- skin graft
بعدها نخلي شاش و نغطي الجرح dressing esp. vacuum-assisted dressings.
و يوميه ننظفه و نغطيه
في كمان option اللي هو :
hyperbaric oxygen (HBO) in high-pressure chamber
(improves neutrophil function & promotes wound healing)
نخلي المرضى ب high-pressure chamber
و نعطي 100% O2
بضغط
2-3 atm
#Necrotising fasciitis
#Davidson
#Surgery_rotation
https://t.me/Surgery_Practice
👍2
■Signs & symptoms Of intestinal Obstruction:
•Abdominal Pain
•Vomiting
•Distension
•Absolute constipation
•Exaggerated Bowel Sounds (Mechanical Obstruction)
•Visible Peristalsis (Mechanical Obstruction)
■Mechanical Obstruction
•Exaggerated Bowel Sounds
■Functional Obstruction (Paralytic ileus)
•Diminished Bowel Sounds
■Main complications after abdominal surgery
•Paralytic ileus
•Bleeding & Abscess
•Anastomotic leakage
■Paralytic ileus After Surgery
•Detected After 72h Of the Surgery
•No Bowel Sounds
•No passage of Flatus
•Abdominal Pain
•Vomiting
•Distension
•Absolute constipation
•Exaggerated Bowel Sounds (Mechanical Obstruction)
•Visible Peristalsis (Mechanical Obstruction)
■Mechanical Obstruction
•Exaggerated Bowel Sounds
■Functional Obstruction (Paralytic ileus)
•Diminished Bowel Sounds
■Main complications after abdominal surgery
•Paralytic ileus
•Bleeding & Abscess
•Anastomotic leakage
■Paralytic ileus After Surgery
•Detected After 72h Of the Surgery
•No Bowel Sounds
•No passage of Flatus
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■ Signs of Thyrotoxicosis (Hyperthyroidism)
▪︎Exophthalmos
•Bulging of the eye anteriorly out of the orbit.
▪︎Ophthalmoplegia
•Weakness of the ocular muscles prevents the patient from looking upwards and outwards.
▪︎lid retraction
•Displacement of the upper eyelid superiorly or lower eyelid inferiorly Because the autonomic part of the levator palpebrae superioris muscle is hypertonic. (you can see Sclera above the iris)
▪︎Lid lag
•The upper eyelid stay high or lag during the Downward movement of the eye (upper eyelid does not keep pace with the eye) Because increased tone of the levator palpebrae superioris muscle.
▪︎Chemosis (Eye inflammation)
•Oedema of the conjunctiva
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎Exophthalmos
•Bulging of the eye anteriorly out of the orbit.
▪︎Ophthalmoplegia
•Weakness of the ocular muscles prevents the patient from looking upwards and outwards.
▪︎lid retraction
•Displacement of the upper eyelid superiorly or lower eyelid inferiorly Because the autonomic part of the levator palpebrae superioris muscle is hypertonic. (you can see Sclera above the iris)
▪︎Lid lag
•The upper eyelid stay high or lag during the Downward movement of the eye (upper eyelid does not keep pace with the eye) Because increased tone of the levator palpebrae superioris muscle.
▪︎Chemosis (Eye inflammation)
•Oedema of the conjunctiva
#Surgery_rotation
https://t.me/Surgery_Practice
❤2
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