❇️ The commonest cause of intestinal obstruction in infants is intussusception
❇️ The commonest cause of intestinal obstruction in young people is adhesions.
❇️ The commonest cause of intestinal obstruction in elderly people is malignancy, especially colon cancer.
❇️ أشيع سبب لانسداد الامعاء عند الرضع هو الانغلاف المعوي
❇️ أشيع سبب لانسداد الامعاء عند الشباب الالتصاقات
❇️ أشيع سبب لانسداد الأمعاء عند المسنين السرطانات وخاصة سرطان القولون .
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❇️ The commonest cause of intestinal obstruction in young people is adhesions.
❇️ The commonest cause of intestinal obstruction in elderly people is malignancy, especially colon cancer.
❇️ أشيع سبب لانسداد الامعاء عند الرضع هو الانغلاف المعوي
❇️ أشيع سبب لانسداد الامعاء عند الشباب الالتصاقات
❇️ أشيع سبب لانسداد الأمعاء عند المسنين السرطانات وخاصة سرطان القولون .
#Short_Note_in_surgery
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Prayer sign
I DM type 1
2 dupytren contracture
3 scleroderma
4 palmar fascitis
5 tenosynovitis of finger flexor
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I DM type 1
2 dupytren contracture
3 scleroderma
4 palmar fascitis
5 tenosynovitis of finger flexor
#Surgery_rotation
https://t.me/Surgery_Practice
🔴Gallstones (Cholelithiasis) & Cholysystitis
▪️Gallstones Are Most Common Biliary Pathology (Affect 10-15% Of Population)
▪️Cholecystitis is Acute Or Chronic
Inflammation Of Gallbladder (Mostly Due To Presence Of Gallstones)
▪︎Cholysystitis is The 2nd Most Common Non-Obstetric Indication For Surgery in Pregnant Women (After Appendicitis)
🔹Risk Factors For Gallstones Formation (Fat/Fertile/Female/Forty)
1. Obesity & High Calorie Intake (Increase Cholesterol & Concentrate The Bile)
2. Terminal Ileum Resection (Diminished EnteroHepatic Circulation)
3. Drugs (Oral Contraceptives/Estrogen/CloFibrate/Cholestyramine/DeoxyCholate)
4. Abnormal Emptying Of Gallbladder
5. Female Gender & Pregnancy (MultiParity)
6. Liver Diseases & DM
7. Rapid Weight Loss
8. Risk Factors For Pigmented Stones ➡️ Blood Hemolysis/Biliary Stasis (Obstruction & Infection)/Liver Cirrhosis
9. Old Age
10. Long Term Parenteral Nutrition
🔹Clinical Features Of Gallstones
📍1. Most Gallstones Asymptomatic (>80%)
📍2. Acute Cholecystitis
▪︎Start As Mild To Moderate Episodes Of Right Upper Quadrant Or Epigastric Pain
▪️Dull Or Colicky in Nature
▪️Radiate To Back Or Right Shoulder
▪️Intermittent Episodes (Comes & Go During The Day) & Constant in Severity
▪️Associated With Dyspepsia & Flatulence & Food Intolerance & Alteration in Bowel Frequency
▪️Aggravated Or Induced By Eating Fatty Meals
📍3. Biliary Colic (10-25%)
▪️Severe RUQ Pain Last Minutes Or Hours Radiate To Chest & Associated With Nausea & Vomiting
▪︎Due To Temporary Stone Obstructing The Cystic Duct
▪️Change In Severity (Ebbs & Flows)
▪️Starts During Night & Wakes Patient From Sleep & Associated With Minor Intermittent Episodes During The Day
▪️When Pain Resolve The Patient is Able To Eat & Drinks Again
📍4. Obstructive Jaundice (Jaundice With Pale Stool & Dark Urine & Itching)
▪︎Due To CBD Stones ➡️ Stone Migration From Gallbladder To Common Bile Duct
▪︎Or Due To Mirizzi Syndrome ➡️ Stones Impacted in Hartmann Pouch Of The Gallbladder & Causing Pressure Over The CBD (Risk Of CBD Fistula)
🔹Types Of Cholysystitis
📍1. Calculus Cholecystitis (Acute/Chronic) ➡️ Due To Gallstones
📍2. Acalculous Cholecystitis ➡️
▪️Gallbladder Inflammation Without The Presence Of Gallstones
▪️Mostly Seen in ➡️ Critically ill Patients/Patients Recovering From Major Surgery Or Trauma Or Burns/Immunocompromised/Typhoid Fever
▪️High Mortality Rate
📍3. Emphysematous Cholecystitis
▪︎Acute Severe & Life-Threatening Cholecystitis Due To Gas-Forming Bacterial infection Of The Gallbladder (C.Perfingrens/C.Welchii/E.coli/Bacteroides Fragilis)
▪︎More in Men With DM (50-70 Years)
▪︎Risk Of Gallbladder Gangrene & Perforation
🔹Dx Of Acute Cholecystitis
📍1. Persistent Clinical Features With Fever
📍2. +Ve Murphy Sign ➡️ RUQ Tenderness Exacerbated By Right SubCostal Palpation During Patient Inspiration
📍3. Leukocytosis & Increase Liver Enzymes
📍4. Palpable Mass in RUQ (Omentum Walls Off The Inflamed Bladder)
📍5. US Or CT (Confirm Dx) ➡️ Stones Present With Gallbladder Wall Thickening & Fluid Collection
🔹DDX Of Acute Cholecystitis
1. Acute Appendicitis
2. Perforated Peptic Ulcer
3. Acute Pancreatitis
4. Acute Pyeleonephritis
5. Myocardial Infarction
6. Right Lower Lobe Pneumonia
#Surgery_rotation
https://t.me/Surgery_Practice
▪️Gallstones Are Most Common Biliary Pathology (Affect 10-15% Of Population)
▪️Cholecystitis is Acute Or Chronic
Inflammation Of Gallbladder (Mostly Due To Presence Of Gallstones)
▪︎Cholysystitis is The 2nd Most Common Non-Obstetric Indication For Surgery in Pregnant Women (After Appendicitis)
🔹Risk Factors For Gallstones Formation (Fat/Fertile/Female/Forty)
1. Obesity & High Calorie Intake (Increase Cholesterol & Concentrate The Bile)
2. Terminal Ileum Resection (Diminished EnteroHepatic Circulation)
3. Drugs (Oral Contraceptives/Estrogen/CloFibrate/Cholestyramine/DeoxyCholate)
4. Abnormal Emptying Of Gallbladder
5. Female Gender & Pregnancy (MultiParity)
6. Liver Diseases & DM
7. Rapid Weight Loss
8. Risk Factors For Pigmented Stones ➡️ Blood Hemolysis/Biliary Stasis (Obstruction & Infection)/Liver Cirrhosis
9. Old Age
10. Long Term Parenteral Nutrition
🔹Clinical Features Of Gallstones
📍1. Most Gallstones Asymptomatic (>80%)
📍2. Acute Cholecystitis
▪︎Start As Mild To Moderate Episodes Of Right Upper Quadrant Or Epigastric Pain
▪️Dull Or Colicky in Nature
▪️Radiate To Back Or Right Shoulder
▪️Intermittent Episodes (Comes & Go During The Day) & Constant in Severity
▪️Associated With Dyspepsia & Flatulence & Food Intolerance & Alteration in Bowel Frequency
▪️Aggravated Or Induced By Eating Fatty Meals
📍3. Biliary Colic (10-25%)
▪️Severe RUQ Pain Last Minutes Or Hours Radiate To Chest & Associated With Nausea & Vomiting
▪︎Due To Temporary Stone Obstructing The Cystic Duct
▪️Change In Severity (Ebbs & Flows)
▪️Starts During Night & Wakes Patient From Sleep & Associated With Minor Intermittent Episodes During The Day
▪️When Pain Resolve The Patient is Able To Eat & Drinks Again
📍4. Obstructive Jaundice (Jaundice With Pale Stool & Dark Urine & Itching)
▪︎Due To CBD Stones ➡️ Stone Migration From Gallbladder To Common Bile Duct
▪︎Or Due To Mirizzi Syndrome ➡️ Stones Impacted in Hartmann Pouch Of The Gallbladder & Causing Pressure Over The CBD (Risk Of CBD Fistula)
🔹Types Of Cholysystitis
📍1. Calculus Cholecystitis (Acute/Chronic) ➡️ Due To Gallstones
📍2. Acalculous Cholecystitis ➡️
▪️Gallbladder Inflammation Without The Presence Of Gallstones
▪️Mostly Seen in ➡️ Critically ill Patients/Patients Recovering From Major Surgery Or Trauma Or Burns/Immunocompromised/Typhoid Fever
▪️High Mortality Rate
📍3. Emphysematous Cholecystitis
▪︎Acute Severe & Life-Threatening Cholecystitis Due To Gas-Forming Bacterial infection Of The Gallbladder (C.Perfingrens/C.Welchii/E.coli/Bacteroides Fragilis)
▪︎More in Men With DM (50-70 Years)
▪︎Risk Of Gallbladder Gangrene & Perforation
🔹Dx Of Acute Cholecystitis
📍1. Persistent Clinical Features With Fever
📍2. +Ve Murphy Sign ➡️ RUQ Tenderness Exacerbated By Right SubCostal Palpation During Patient Inspiration
📍3. Leukocytosis & Increase Liver Enzymes
📍4. Palpable Mass in RUQ (Omentum Walls Off The Inflamed Bladder)
📍5. US Or CT (Confirm Dx) ➡️ Stones Present With Gallbladder Wall Thickening & Fluid Collection
🔹DDX Of Acute Cholecystitis
1. Acute Appendicitis
2. Perforated Peptic Ulcer
3. Acute Pancreatitis
4. Acute Pyeleonephritis
5. Myocardial Infarction
6. Right Lower Lobe Pneumonia
#Surgery_rotation
https://t.me/Surgery_Practice
❤2👍1
Surgical Practice Dr. alqhatani
🔴Gallstones (Cholelithiasis) & Cholysystitis ▪️Gallstones Are Most Common Biliary Pathology (Affect 10-15% Of Population) ▪️Cholecystitis is Acute Or Chronic Inflammation Of Gallbladder (Mostly Due To Presence Of Gallstones) ▪︎Cholysystitis is The 2nd…
🔹Mx Of Cholecystitis
🔸A. Conservative
▪️Conservative Mx Will Resolve The Symptoms in 90% Of Cases
📍1. Nill By Mouth (NPO)
📍2. IV Fluids & Analgesic
📍3. Antibiotics (Cefazolin/Cefuroxime/Ciprofloxacin)
🔸B. Surgery (Cholecystectomy)
📍1. Do Early CholecysteCtomy Within 5-7 Days From Admission & After Symptoms Resolution
📍2. Emergent Choleystectomy ➡️ Due To Severe Presentation Or Complications
📍3. Do Emergent ECRP ➡️ For CBD Stones Removal
📍4. If Empyema Present ➡️ Do Drainage (CholeCystoStomy) Then Later CholecysteCtomy
📍5. Cholecystitis in Pregnancy ➡️ Do Cholecystectomy During 2nd Trimester Only (Not In 1st Or 3rd Trimester)
🔹Indications for Cholecystectomy
1. Cholecystitis (Symptomatic Patients)
2. Complications Develop (Emergency)
3. Typhoid Carrier
4. Cholesterolosis (Cholesterol Polyps)
5. Risk Of Gallbladder Cancer (Porcelain Gallbladder/Adenomatous Gallbladder Polyps)
6. CBD Stones (Choledocholithiasis)
7. Prophylaxis in
▪︎DM/Congenital Hemolytic Anaemia/Bariatric Surgery
▪︎Large Palpable Stones (>2.5-3cm)/Multiple Small Stones
🔹Complications Of Cholecystitis
🔶A. Preoperative
1. Acute & Chronic Cholecystitis
2. Biliary Colic
3. Obstructive Jaundice (CBD Stones Or Mirizzi Syndrome)
4. Acute Pancreatitis
5. Gallbladder Perforation & Peritonitis
6. Acute Cholangitis
7. Empyema Of Gallbladder (Pus Accumulation)
8. MucoCele Of Gallbladder (Fluid Accumulation)
9. Bowel Obstruction (Gallstone Ileus)
🔶B. Postoperative (After CholecysteCtomy)
1. Bile Ducts Injury ➡️ Present As Postoperative Obstructive Jaundice
2. Post-CholecysteCtomy Syndrome ➡️ Postoperative Continuation Of The Symptoms Due To Residual Stones in The Biliary Tree
3. Post-CholecysteCtomy Choledocholithiasis ➡️ Development Of New Stones in Bile Ducts Many Years After Cholecystectomy Which Then Leads To Obstruction Or Cholangitis
4. Bile Leakage & Peritonitis (Clips Dislodgment)
5. Biliary Strictures
6. Visceral Or Vessels Injury & Haemorrhage
7. Abdominal Abscess
#Surgery_rotation
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🔸A. Conservative
▪️Conservative Mx Will Resolve The Symptoms in 90% Of Cases
📍1. Nill By Mouth (NPO)
📍2. IV Fluids & Analgesic
📍3. Antibiotics (Cefazolin/Cefuroxime/Ciprofloxacin)
🔸B. Surgery (Cholecystectomy)
📍1. Do Early CholecysteCtomy Within 5-7 Days From Admission & After Symptoms Resolution
📍2. Emergent Choleystectomy ➡️ Due To Severe Presentation Or Complications
📍3. Do Emergent ECRP ➡️ For CBD Stones Removal
📍4. If Empyema Present ➡️ Do Drainage (CholeCystoStomy) Then Later CholecysteCtomy
📍5. Cholecystitis in Pregnancy ➡️ Do Cholecystectomy During 2nd Trimester Only (Not In 1st Or 3rd Trimester)
🔹Indications for Cholecystectomy
1. Cholecystitis (Symptomatic Patients)
2. Complications Develop (Emergency)
3. Typhoid Carrier
4. Cholesterolosis (Cholesterol Polyps)
5. Risk Of Gallbladder Cancer (Porcelain Gallbladder/Adenomatous Gallbladder Polyps)
6. CBD Stones (Choledocholithiasis)
7. Prophylaxis in
▪︎DM/Congenital Hemolytic Anaemia/Bariatric Surgery
▪︎Large Palpable Stones (>2.5-3cm)/Multiple Small Stones
🔹Complications Of Cholecystitis
🔶A. Preoperative
1. Acute & Chronic Cholecystitis
2. Biliary Colic
3. Obstructive Jaundice (CBD Stones Or Mirizzi Syndrome)
4. Acute Pancreatitis
5. Gallbladder Perforation & Peritonitis
6. Acute Cholangitis
7. Empyema Of Gallbladder (Pus Accumulation)
8. MucoCele Of Gallbladder (Fluid Accumulation)
9. Bowel Obstruction (Gallstone Ileus)
🔶B. Postoperative (After CholecysteCtomy)
1. Bile Ducts Injury ➡️ Present As Postoperative Obstructive Jaundice
2. Post-CholecysteCtomy Syndrome ➡️ Postoperative Continuation Of The Symptoms Due To Residual Stones in The Biliary Tree
3. Post-CholecysteCtomy Choledocholithiasis ➡️ Development Of New Stones in Bile Ducts Many Years After Cholecystectomy Which Then Leads To Obstruction Or Cholangitis
4. Bile Leakage & Peritonitis (Clips Dislodgment)
5. Biliary Strictures
6. Visceral Or Vessels Injury & Haemorrhage
7. Abdominal Abscess
#Surgery_rotation
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📍طريقة إدخال الأنبوب الأنفي المعدي Nasogastric tube insertion
#Surgery_rotation
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#Surgery_rotation
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📍 Acute pancreatitis
❇️ common cause of acute pancreatitis :
Just remember GET and 3i
🔺️GET
1-Gallstone [ The commonest cause ]
2-Ethanol [ The 2nd common cause ]
3-Trauma [ The 3rd common cause ]
🔺️3i
1- Idiopathic [ 20 % ]
2- Infection
3- Infarction [ vascular insufficiency ]
♦️ CLINICAL FEATURES
🔷 Main symptom is Severe upper abdominal pain radiating to the back increase on supine position and relieve by laying forward
May be associated with
🔷 Vomiting
🔷 Mild tenderness and rigidity
#Pancreas
#جراحة
https://t.me/Surgery_Practice
❇️ common cause of acute pancreatitis :
Just remember GET and 3i
🔺️GET
1-Gallstone [ The commonest cause ]
2-Ethanol [ The 2nd common cause ]
3-Trauma [ The 3rd common cause ]
🔺️3i
1- Idiopathic [ 20 % ]
2- Infection
3- Infarction [ vascular insufficiency ]
♦️ CLINICAL FEATURES
🔷 Main symptom is Severe upper abdominal pain radiating to the back increase on supine position and relieve by laying forward
May be associated with
🔷 Vomiting
🔷 Mild tenderness and rigidity
#Pancreas
#جراحة
https://t.me/Surgery_Practice
Surgical Practice Dr. alqhatani
📍 Acute pancreatitis ❇️ common cause of acute pancreatitis : Just remember GET and 3i 🔺️GET 1-Gallstone [ The commonest cause ] 2-Ethanol [ The 2nd common cause ] 3-Trauma [ The 3rd common cause ] 🔺️3i 1- Idiopathic [ 20 % ] 2- Infection 3- Infarction…
♦️Glasgow criteria for acute pancreatitis
REMEMBER WORD "pancreas":-
🔸P= PO2<60mmhg
🔸A=Age>55
🔸N=neutrophil =WBCs>15,000
🔸C=Calcium <2mmol/L
🔸R=Renal=urea>16mmol/L
🔸E=Enzyme elevated LDH>600
🔸A=Albumin<32gm/L
🔸S=Suger >200mg/dl=10mmol/L
#Pancreas
#جراحة
https://t.me/Surgery_Practice
REMEMBER WORD "pancreas":-
🔸P= PO2<60mmhg
🔸A=Age>55
🔸N=neutrophil =WBCs>15,000
🔸C=Calcium <2mmol/L
🔸R=Renal=urea>16mmol/L
🔸E=Enzyme elevated LDH>600
🔸A=Albumin<32gm/L
🔸S=Suger >200mg/dl=10mmol/L
#Pancreas
#جراحة
https://t.me/Surgery_Practice