📚BROWSE’S INTRODUCTION TO THE SYMPTOMS & SIGNS OF SURGICAL DISEASE

#Surgery_rotation

Clinical_Surgery#

👆🏻هذه بعض المواضيع من كتاب Browse’s
مُقسّمة لسهولة الوصول

■ Surgical Drains || *Important Topic
#Surgery_rotation

💢Under water sealed

▪︎Is a Chest drain inserted to allow draining of the pleural spaces of air, blood or fluid, allowing expansion of the lungs and restoration of negative pressure in the thoracic cavity.

▪︎Active Close System

▪︎The water in the water seal chamber will rise and fall (swing) with respirations. This will diminish as the pneumothorax resolves.

▪︎Watch for unexpected cessation of swing as this may indicate the tube is blocked or kinked


🔹Indications for Insertion of a Chest Drains:
▪︎Post operatively e.g. cardiac surgery, thoracotomy

▪︎Pneumothorax

▪︎Haemothorax

▪︎Chylothorax

▪︎Pleural effusions


🔹Indications for Removal of Chest Drains:
▪︎Absence of an air leak (pneumothorax)

▪︎Drainage diminishes to little or nothing

▪︎No evidence of respiratory compromise

▪︎Chest x-ray showing lung re-expansion

#Drains
#Surgery_rotation
https://t.me/Surgery_Practice

❇️The 'safe triangle' for chest drain insertion

🔹bounded anteromedially by the lateral border of pectoralis major

🔹inferiorly by a horizontal line at the level of the nipples

🔹posteriorly by the anterior border of latissimus dorsi.

This area is 'safe' because it avoids damage to the chest wall muscles and breast.

#Drains
#Surgery_rotation
https://t.me/Surgery_Practice

■Detailed History of Lump/Ulcer

بالإضافة لـ تحديد ⬇️ :
✅ Site
✅ Laterality ( Unilateral/ bilateral) If it is in Extremities
✅ Size e.g ( bean like ,lemon like)
✅ Number ( single or Multiple)
✅ Depth ( Is it reach to Muscle/bone)

#Ulcer
#Surgery_rotation
https://t.me/Surgery_Practice

✅ Types of ulcer edges

▪︎Sloping edge : healing, traumatic and ischaemic venous ulcers.

▪︎Undermined edge : TB

▪︎Punched-out edge : ischaemic and syphilitic ulcers

▪︎Rolled edge : basal cell carcinoma

▪︎Everted edge : squamous cell carcinoma and the ulcerated adenocarcinoma.

#Ulcer
#Surgery_rotation
https://t.me/Surgery_Practice

✅ Pressure sores ( bed Ulcers)

Definition : pressure sores or bedsores are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin.

•affect people confined to bed or sit in a chair for long periods of time.

#Site
#Grade
#Prevention

#bed sore #ulcer
#Surgery_rotation
https://t.me/Surgery_Practice

Diabetic Foot (Clinical Practice)

✅ Definition: Diabetic foot is defined simply as any foot pathology that results from the long term complications of diabetes mellitus mainly neuropathy and angiopathy. The foot pathology may include foot infection, ulceration, and osteoarthropathy.

✅ Main risk factors of diabetic foot are:
➢ Poor glycemic control.
➢ Duration of D.M more than 10 yrs.
➢ Age, Smoking and Male gender.
➢ Obesity.
➢ Peripheral vascular disease.
➢ Peripheral neuropathy.
➢ Diabetic nephropathy and retinopathy.
➢ Foot deformity (abnormal foot structure).
➢ Previous history of foot ulceration/ gangrene.

#Diabetic_Foot_ulcer
#Surgery_rotation
https://t.me/Surgery_Practice

Grades of diabetic foot ulcer :-

✅ Wagner classification:-

➢ Grade 0: intact skin in high risk patients (no ulcer).
➢ Grade 1: superficial ulcer involving the skin and subcutaneous tissues.
➢ Grade 2: deep ulcer involving muscles, tendons & joint capsule without bony
involvement.
➢ Grade 3: bony involvement (osteomyelitis).
➢ Grade 4: localized gangrene as gangrene of a toe or heel only.
➢ Grade 5: extensive gangrene involving most of the foot.

#Diabetic_Foot_ulcer
#Surgery_rotation
https://t.me/Surgery_Practice

The important points in history of a diabetic patient with foot ulceration

✅ Regarding ulcer:
➢ Onset.
➢ Duration.
➢ Pain.
➢ Discharge (color, amount, odor)
➢ Bleeding.
➢ Progression of ulcer over time.
➢ Preceding trauma.
➢ Previous foot ulceration

✅ Regarding diabetes:
➢ Duration of DM.
➢ Glycemic control (dietary modification, medications, or insulin).
➢ Compliance to treatment.
➢ History of diabetic complications as:
1. Peripheral vascular diseases : intermittent claudication (muscles cramping/ fatigue in
one or both lower extremities on walking for a certain distance and relieved by resting
for several minutes) , rest pain, and change in leg color.
2. Peripheral neuropathy: as weakness of lower extremities (motor), impaired sensation
as hyposthesia, paresthesia, and hyperesthesia (sensory) and skin dryness
(autonomic).
3. Diabetic retinopathy: any problem in vision.
4. Diabetic nephropathy: any renal problem.

✅ Foot history:
➢ Daily activities including work.
➢ Footwear: whether shoes, slippers, sandals, or different footwears, and whether the
footwear is fit, lose, or tight.
➢ Foot care: inspect foot daily, aware of foot problem, foot washing, and proper nail care and trimming.
➢ History of Callus formation and foot deformity as Charcot deformity.
➢ Previous history of foot infection, blisters, ingrown toenail, and foot surgery.

✅ Social history: including occupation, smoking, and alcoholism.
✅ Past medical/ surgical history.
✅ Drug history: including medications in current use and allergies.

#Diabetic_Foot_ulcer
#Surgery_rotation
https://t.me/Surgery_Practice

Staging of bed sores ( Ulcer)
#bed sore #ulcer
#Surgery_rotation
https://t.me/Surgery_Practice