🔷Types Of Peritonitis
📍A. Localized Peritonitis
▪︎Inflammation Of Localized Area Of The Peritoneum

▪︎Due To Local Organ Inflammation (Appendicitis/Salpingitis)


📍B. Diffuse (Generalised) Peritonitis
▪︎Life Threatening Diffuse Inflammation Of The Entire Peritoneum

▪︎Due To
I.Perforation Of Viscous

II.Ruptured Aortic Aneurysm (Large Amount Of Blood Enter The Peritoneum)

III.Anastomotic Leakage

▪Factors Increase Risk Of Diffuse Peritonitis
I.Young Children (Small Omentum Less Effective in Localising The Infection)

II.Stimulation Of Bowel Peristalsis By Food Intake

III.Highly Virulent Organisms

IV.Disruption Of Localized Collection (Abscess) During Surgical Manipulation

V.immune Deficiency

VI.Rapid Peritoneal Contamination (Mostly After Viscous Perforation)


🔷Clinical Features Of Peritonitis
📍1. Abdominal Pain
▪︎Start As Localized Then Becomes Diffuse

▪︎Acute Or Gradual Onset

▪︎Sharp & Constant

▪︎Aggravated By Movement/Coughing/Deep Respiration

▪︎Pain Radiating To Shoulder Or Back (Referred Pain)

▪︎+Ve Rebound Tenderness (Worsening Pain On Sudden Hand Lifting From The Abdomen)

▪︎Pain & Tenderness On Rectal Or Vaginal Examination (Pelvic Peritonitis)


📍2. Contraction Of Abdominal Muscles
▪︎Guarding (Voluntary Contraction)

▪︎Rigidity (involuntary Contraction)

▪︎Board-Like Rigidity (Diffuse Involuntary Contraction) ➡️ More With Diffuse Peritonitis


📍3. Generalised Ileus
▪︎Absent Or Decrease Bowel Sounds
▪︎Then Abdominal Distention


📍4. Fever & Anorexia & Malaise With Hypotension & Tachycardia


📍5. Cold Extremities With Sunken Eyes & Dry Tongue & Thready Irregular Pulse & Anxious Face (Hippocratic Face)


📍6. Disorientation Then Loss Of Consciousness


📍7. Septic Shock Then Multiple Organs Failure & Death (If Not Treated)


🔷Dx Of Acute Peritonitis
📍1. Hx & Examination


📍2. Blood Ix
▪︎Leckocytosis (Neutrophilia)
▪︎Elevated ESR & CRP


📍3. Erect Or Lateral Decubitus Xray
▪︎Gas Under Diaphragm (Perforated Viscous)

▪︎Multiple Air-Fluid Levels & Dilated Bowel Loops (Ileus)


📍4. Abdominal CT Scan (Best) ➡️ Ix Of Choice To Detect Cause Of Peritonitis


📍5. US ➡️ For Tubo-Ovarian Diseases


📍6. Amylase & Lipase ➡️ To Exclude Acute Pancreatitis


📍7. Laparoscopy ➡️ If Other Ix Failed To Reach The Cause Of Peritonitis


🔷Complications Of Peritonitis
1. Septic Shock
2. Multiple Organs Dysfunction
3. Systemic Inflammatory Response
4. Paralytic Ileus
5. Abscess Or Inflammatory Mass Formation
6. Portal Pyaemia & Liver Abscess
7. Adhesion & Small Bowel Obstruction
8. Death


🔷Mx Of Acute Peritonitis
1. Fluids & Electrolytes Correction

2. NG Tube Decompression & Urinary Catheter

3. Broad Spectrum IV Antibiotics ➡️ Metronidazole 500mg + Cefuroxime 750mg

4. Analgesics

5. Determine The Cause & Treat It

6. Surgical Peritoneal Lavage Or Drainage

Peritonitis Part 2
#Surgery_rotation
https://t.me/Surgery_Practice

فيديوهات لtechniques في الDRcABCDE Approach 👇 :

📌 Cervical stability:

     📍Neck collar:
https://youtu.be/hHHy1mc7sqY
---------------------------------------------------

📌 Airway:

     📍Head tilt- Chin lift, Jaw
       thrust maneuvers:
https://youtu.be/5iwogajl-n8

     📍Oropharyngeal airway:
https://youtu.be/Hzc_T4QBp4E

     📍Nasopharyngeal airway:
https://youtu.be/gVgAlWRCZBs
https://youtu.be/f_kUeNjRw28

     📍Endotracheal intubation:
https://youtu.be/pXjyeHMYqUI
---------------------------------------------------

📌 Breathing:

     📍Respiratory distress:
https://youtu.be/5OR-0zuw9v0

     📍Needle decompression of
         Tension Pneumothorax:
https://youtu.be/2eZnT3V6cT8
---------------------------------------------------

📌 Circulation:

     📍Capillary Refill Time:
https://youtu.be/EwaDSZRH1LE

     📍IV Cannula insertion:
https://youtu.be/xnzUdr3c6wE

     📍 Urinary Catheterization:
https://youtu.be/XcU6g_ppWRI
https://youtu.be/Stc5mzIFJBY

     📍Applying Torniquet:
https://youtu.be/BVij7f6Brgo
---------------------------------------------------

📌 Disability:
    
    📍How to measure GCS:
https://youtu.be/vxOpsig-ft0

    📍Pupil examination:
https://youtu.be/ROEiGc_j2u4

    📍Neurological examination:
https://youtu.be/vZBpNsFPJVQ

📌 Videos for Hand Skills👇

📍How to insert a cannula (in    
     Arabic):

https://youtu.be/_XhDMtTQruI?si=mnBNQ6SNjPgaFG98
---------------------------------------------------

📍How to insert a urinary
     catheter:

👉 Male (in Arabic):
https://youtu.be/YnjAXc7B2mA?si=3wHW1AdfAh1s-SMH

👉 Female (in Arabic):
https://youtu.be/VAwKWqJSXjw?si=oxb0H_Sx4K66TYtk
---------------------------------------------------

📍How to take ABG (in Arabic):
    
https://youtu.be/MhCrMhQFNIo?si=2SuU5ASrCMnLuIg3

https://youtu.be/narqCoAlSWk?si=Cn9x3fHA52Wl2OCI
---------------------------------------------------

📍How to insert a Ryle or NGT
    (in Arabic):

https://youtu.be/SfiuYrFySUA?si=KEFQB-lm2AV4E3md

https://youtu.be/CQjTE72rOxk?si=W3Jnv2tDkKSsQUjH
---------------------------------------------------

📍How to insert an
     Endotracheal tube:

https://youtu.be/pXjyeHMYqUI?si=5NqNl18agzkW9U33
----------------------------------------------------

📌 Twist Score For Testicular Torsion

✅ Interpretation :

< 0–2 points: Low risk – torsion unlikely.

3–4 points: Intermediate risk – consider ultrasound.

5–7 points: High risk – immediate surgical intervention recommended.

#clinical
@Surgery_Practice

✅ هدية لزملاءنا اللي بيدرسوا جراحة 🤩🔥

بعدما تكمل اي شابتر بالجراحة كن ادخل واتناقش مع مرجع بيلي اند لاف رأساً 😁😂🏃‍♂

https://chatgpt.com/g/g-67f993f6c17881918e5df1842404d791-bailey-and-love


✅ هدية لزملائنا اللي بيدرسوا باطنة  🤩🔥

بعدما تكمل اي شابتر بالباطنة كن ادخل واتناقش مع مرجع دافيدسون رأساً 😁😂🏃‍♂

https://chatgpt.com/g/g-68090185b8a08191bff1b1e03d9c87ed-davidson-s-of-medicine-24th


✅ هدية لزملائنا اللي بيدرسوا نسائية 🤩🔥

بعدما تكمل اي شابتر بالنسائية كن ادخل واتناقش مع مرجع تين تيتشر رأساً 😁😂🏃‍♂
Chat GPT Gyn

https://chatgpt.com/g/g-681f83694f80819183fed44e8e4d31b9-gynaecology-by-ten-teachers

✅ هدية لزملاءنا اللي بيدرسوا توليد 🤩🔥

بعدما تكمل اي شابتر بالتوليد obs كن ادخل واتناقش مع مرجع تين تيتشر رأساً 😁😂🏃‍♂

Chat GPT Obstetrics

https://chatgpt.com/g/g-682f1ca961f481918e445642944a5672-obstetricspartner

https://t.me/M_Information11

🗯 Paralytic ileus :
failure of trans mission of peristaltic waves secondary to neuromuscular failure.  

♦️Causes:

🔹Postoperative : within 24 - 72 hours , if prolonged means there is hypo- proteinemia.  

🔹Infection: intra-abdominal sepsis  

🔹Reflex ileus: this may occur following fractures of the spine or ribs, retroperitoneal haemorrhage  

🔹Metabolic: uraemia and hypokalaemia  

♦️Clinical features  :
Paralytic ileus takes on a clinical signifcance if, 72 hours after laparotomy: 

● there has been no return of bowel sounds on auscultation.
● there has been no passage of fatus.

❗️Abdominal distension becomes more marked and tympanitic.  

❌ Colicky pain is not a feature. 

❗️Distension increases pain from the abdominal wound.  

♦️Management  :
❗️Nasogastric tubes are not required routinely after elective intra-abdominal surgery.  

🔹nasogastric suction

🔹 restriction of oral intake until bowel sounds and the passage of flatus return.  

🔹Electrolyte balance.  

❗️The need for a laparotomy becomes increasingly likely the longer the bowel inactivity persists, particularly if it lasts for more than 7 days or if bowel activity recommences following surgery and then ceases.

#Git #surgery   
https://t.me/M_Information11

✅ Thyroid Diseases Guidelines

#clinical  #surgery
@M_Information11

▪︎Radiating pain: (ينتشر)

•Starts in one area of the body and spreads along the path of the nerve to the other areas supplied by the same nerve

•Herniated or bulging disc Pain start in the back and then progress to the legs (same nerve supply)


▪︎Referred pain:

•Pain felt at area not involved in the injury (Pain felt away from the real source) Because the sensory nerve fibres of these different areas meet at the same level in the spinal cord

•Pain of MI felt in the left side of neck, left shoulder, and back rather than in chest (chest is the real site of the injury)


▪︎Migratory (Shifting) pain :

•Pain starts at site Generalized not specific due to stimulation of the Visceral afferent fibers then shifted to the injury site to become localized after stiumation of the Parietal (Somatic) Nerve Fibers and dissappear from the origin Site.

•During acute appendicitis the pain start at the para umbilical area then localized to the RLQ area

#clinical  #surgery
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

❇️Truma Basics

💢History of trauma

1. Cognitive function: ask who they are, where they live and their occupation.

2. History of the accident: ask the patient what they remember of the accident, and useful if they can describe what happened.


•Type of the Accident

🔹Gunshot:

▪︎Type of machine: low velocity (pistol), high velocity (gun)

▪︎Number of bullets

▪︎Distance from shooter

▪︎Site of inlet and outlet


🔹Road traffic accident:

▪︎Was he the walker (on the street, sidewalk),

▪︎driver, passenger (front or back seats)

▪︎protection (seat belts, airbags)

▪︎Others in accident: injured, dead.

▪︎Type of car and its speed (low or high velocity)

▪︎Damage to the vehicle: collision, rolling


🔹Fall from a height:

▪︎Height of fall

▪︎Did the patient hit anything on his way?

▪︎What position was the body at time of impact?


3. Walking after accident: to exclude pelvic and lower limb injuries.

4. Associated symptoms: Loss of consciousness, bleeding, vomiting, urination, cough, dyspnea .

5. Transportation: car, ambulance

6. The distance of the hospital

7. What resuscitation and procedures done? What organs was damaged.

#clinical  #surgery
https://t.me/Surgery_Practice

💢A Airway

🔹airway may be compromised due to:

▪︎Blood or swelling in the airway

▪︎Vomit or secretions

▪︎Reduced consciousness


🔹Clinical assessment

▪︎Can the patient talk? 

•Yes ➡️ Patent Airway
•No ➡️ Check Airway 👇

1) Look for signs of airway compromise:
•cyanosis
•see-saw breathing
•use of accessory muscles
•diminished breath sounds
•added sounds (Stridor)

2) Open the mouth and inspect: look for anything obstructing the airway such as secretions or a foreign object

3) Interventions

▪︎Head-tilt chin-lift manoeuvre
•If No Spine Injury
•Push head to the back
•Pull chin Downward

▪︎Jaw thrust Maneuver
•If there is Spine Injury

▪︎Oropharyngeal Tube
▪︎Nasopharyngeal Tube

#clinical  #surgery
https://t.me/Surgery_Practice