The recommended systolic BP target in trauma patients WITHOUT head injury is:
Anonymous Quiz
20%
A) >120 mmHg
57%
B) 100–110 mmHg
18%
C) 70–90 mmHg
6%
D) 70– 80 mmHg
The tertiary survey is best described as:
Anonymous Quiz
8%
A) Initial rapid assessment in the emergency department
32%
B) Full head-to-toe examination
48%
C) Repetition of primary and secondary survey within 24 hours
12%
D) Imaging-based reassessment
👍2
🔴Acute Appendicitis
▪︎Acute Inflammation Of Appendix After Lumen Obstruction & Bacterial Proliferation
▪︎More in Children & Young Adults (15-30 Years) & More in Males After Puberty
▪︎Most Common Cause Of Acute Abdomen in Young Adults & Most Common Surgical Emergency
▪︎Most Common ExtraUterine Cause Of Acute Abdomen During Pregnancy (More in 2nd Trimester & Has A Risk Of Fetal Loss)
▪︎Appendix is The Most Common Site For Carcinoid Tumors (Arise From Kulchitsky Cells)
The Appendix is 7.5-10cm IntraPeriToneal Organ Attached To Caecum Of Large Bowel At Right Iliac Fossa
🔹Risk Factors For Appendicitis
1. Decrease Dietary Fibers & Increase Carbs Intake
2. Lumen Obstruction Of Appendix By Fecolith Or Fibrosis Or Tumors (Carcinoids in Middle Age & Elderly)
3. Intestinal Parasites (Oxyuris Vermicularis Pin Worms)
4. Viral Infections (More in Children)
🔹Position Of Appendix
📍A. Base Of Appendix ➡️ Fixed (Constant) At Confluence Of Three Taeniae Coli Of Caecum
📍B. Tip Of Appendix
1. RetroCaecal (Behind Caecum Most Common 74%)
2. Pelvic (2nd Most Common 21%)
3. ParaCaecal (2%)/SubCaecal (1.5%)
4. Postileal (Behind ileum 0.5%)
🔹Clinical Features & Dx
🔶A. Hx
📍1. Start As Poorly Localized Colicky Intermittent Abdominal Pain At PeriUmbilical Area (Visceral Pain)
📍2. Then After 6-10h The Pain Shifted To RIF & Become More Intense & Localized & Constant (Somatic Pain After Parietal Peritoneal Irritation)
📍3. Pain Aggravated By Coughing & Sudden Movements
📍4. Atypical Pain (Suprapubic Discomfort & Tenesmus Aggravated By Rectal Examination) ➡️ More in Elderly
📍5. Anorexia & Vomiting (More in Children)
📍6. Slight Pyrexia After 6h (37.2-37.7°C) & Tachycardia
📍7. Abrupt Onset & Generalised Abdominal Pain From Start With Vomiting & Normal Temperature (Resemble Bowel Obstruction)
Seen in ➡️ Seen in Obstructive Appendicitis (Closed Lumen)
🔶B. Examination
📍1. Guarding ➡️ Voluntary Abdominal Muscle Contractions Due To Pain After Palpation
📍2. Rebound Tenderness (Blumberg's Sign) ➡️ Pain Elicited After Pressure Removal From The RIF
📍3. Rovsing's Sign ➡️ Pain Elicited After Abdominal Palpation From LIF To RIF (Pushing Bowel Loops Toward The Inflamed Appendix)
📍4. Psoas Sign ➡️ Pain Elicited After Right Hip Extension
📍5. Obturator Sign ➡️ Pain Elicited By Hip Flexion & Internal Rotation
📍6. Pointing Sign ➡️ Patient Pointing Where The Pain Started & Moved
📍7. Dunphy Sign ➡️ Pain Elicited By Cough
📍8. McBurney's Sign ➡️ Severe Pain Elicited By Finger Tip Pressure Over McBurney's Area (Between Umbilicus & Anterior Superior Iliac Spine)
🔶C. Alvarado (Mantrels) Score (≥7 Points Strongly Suggest Appendicitis)
▪︎RIF Tenderness/Leukocytosis ➡️ 2 Points For Each
▪︎Migratory (Shifting) Pain/Anorexia/Nausea & Vomiting/Elevated Temperature/Rebound Tenderness/WBCS Shifting To Left (Immature Segmented Neutrophils Production) ➡️ 1 Point For Each
🔶D. Lab & Imaging
1. US
▪︎Lumen Dilatation >3mm
▪︎Wall Thickness >6mm
2. Contrast CT Of Abdomen (Best)
3. CBC ➡️ Leukocytosis
4. Pregnancy Test To Exclude Ectopic
5. Urinalysis To Exclude UTI & Stones
🔶E. Atypical Features
1. RetroCaecal Appendix ➡️ No Rigidity/Psoas Spasm & Hip Flexion Develop
2. Pelvic Appendix ➡️ Diarehea/Increase Urine Frequency/No Rigidity/Rectal Examination Elicits Tenderness
3. Postileal Appendix ➡️ Retching & Diarrhea/No Pain Shifting/Mild Tenderness
#Appendicitis
#Surgery
https://t.me/Surgery_Practice
▪︎Acute Inflammation Of Appendix After Lumen Obstruction & Bacterial Proliferation
▪︎More in Children & Young Adults (15-30 Years) & More in Males After Puberty
▪︎Most Common Cause Of Acute Abdomen in Young Adults & Most Common Surgical Emergency
▪︎Most Common ExtraUterine Cause Of Acute Abdomen During Pregnancy (More in 2nd Trimester & Has A Risk Of Fetal Loss)
▪︎Appendix is The Most Common Site For Carcinoid Tumors (Arise From Kulchitsky Cells)
The Appendix is 7.5-10cm IntraPeriToneal Organ Attached To Caecum Of Large Bowel At Right Iliac Fossa
🔹Risk Factors For Appendicitis
1. Decrease Dietary Fibers & Increase Carbs Intake
2. Lumen Obstruction Of Appendix By Fecolith Or Fibrosis Or Tumors (Carcinoids in Middle Age & Elderly)
3. Intestinal Parasites (Oxyuris Vermicularis Pin Worms)
4. Viral Infections (More in Children)
🔹Position Of Appendix
📍A. Base Of Appendix ➡️ Fixed (Constant) At Confluence Of Three Taeniae Coli Of Caecum
📍B. Tip Of Appendix
1. RetroCaecal (Behind Caecum Most Common 74%)
2. Pelvic (2nd Most Common 21%)
3. ParaCaecal (2%)/SubCaecal (1.5%)
4. Postileal (Behind ileum 0.5%)
🔹Clinical Features & Dx
🔶A. Hx
📍1. Start As Poorly Localized Colicky Intermittent Abdominal Pain At PeriUmbilical Area (Visceral Pain)
📍2. Then After 6-10h The Pain Shifted To RIF & Become More Intense & Localized & Constant (Somatic Pain After Parietal Peritoneal Irritation)
📍3. Pain Aggravated By Coughing & Sudden Movements
📍4. Atypical Pain (Suprapubic Discomfort & Tenesmus Aggravated By Rectal Examination) ➡️ More in Elderly
📍5. Anorexia & Vomiting (More in Children)
📍6. Slight Pyrexia After 6h (37.2-37.7°C) & Tachycardia
📍7. Abrupt Onset & Generalised Abdominal Pain From Start With Vomiting & Normal Temperature (Resemble Bowel Obstruction)
Seen in ➡️ Seen in Obstructive Appendicitis (Closed Lumen)
🔶B. Examination
📍1. Guarding ➡️ Voluntary Abdominal Muscle Contractions Due To Pain After Palpation
📍2. Rebound Tenderness (Blumberg's Sign) ➡️ Pain Elicited After Pressure Removal From The RIF
📍3. Rovsing's Sign ➡️ Pain Elicited After Abdominal Palpation From LIF To RIF (Pushing Bowel Loops Toward The Inflamed Appendix)
📍4. Psoas Sign ➡️ Pain Elicited After Right Hip Extension
📍5. Obturator Sign ➡️ Pain Elicited By Hip Flexion & Internal Rotation
📍6. Pointing Sign ➡️ Patient Pointing Where The Pain Started & Moved
📍7. Dunphy Sign ➡️ Pain Elicited By Cough
📍8. McBurney's Sign ➡️ Severe Pain Elicited By Finger Tip Pressure Over McBurney's Area (Between Umbilicus & Anterior Superior Iliac Spine)
🔶C. Alvarado (Mantrels) Score (≥7 Points Strongly Suggest Appendicitis)
▪︎RIF Tenderness/Leukocytosis ➡️ 2 Points For Each
▪︎Migratory (Shifting) Pain/Anorexia/Nausea & Vomiting/Elevated Temperature/Rebound Tenderness/WBCS Shifting To Left (Immature Segmented Neutrophils Production) ➡️ 1 Point For Each
🔶D. Lab & Imaging
1. US
▪︎Lumen Dilatation >3mm
▪︎Wall Thickness >6mm
2. Contrast CT Of Abdomen (Best)
3. CBC ➡️ Leukocytosis
4. Pregnancy Test To Exclude Ectopic
5. Urinalysis To Exclude UTI & Stones
🔶E. Atypical Features
1. RetroCaecal Appendix ➡️ No Rigidity/Psoas Spasm & Hip Flexion Develop
2. Pelvic Appendix ➡️ Diarehea/Increase Urine Frequency/No Rigidity/Rectal Examination Elicits Tenderness
3. Postileal Appendix ➡️ Retching & Diarrhea/No Pain Shifting/Mild Tenderness
#Appendicitis
#Surgery
https://t.me/Surgery_Practice
Telegram
Surgical Practice Dr. alqhatani
- تابعة لقناة معلومات طبية:
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
❤3
🔹Mx Of Appendicitis
🔶A. Preoperative Preparation
1. Bowel Rest (Nill By Mouth)
2. IV Fluids (To Establish Urine Output)
3. IV AB (Amoxicillin/Metronidazole/3rd G.Cephalosporins Like Ceftriaxone/Ertapenem)
4. Anti-Pyretics If High Temperature Present (Aspirin For Children Or Paracetamol Vial)
🔶B. Surgical AppendiCectomy (Laparoscopic Or Conventional)
▪︎Types Of Incisions During Conventional Surgery
1. Gridiron (Most Commonly Used) ➡️ Made At McBurney's Area
2. Rutherford Morison ➡️ Give Better Access If Appendix in Para Or RetroCaecal Position
3. Transverse (Lanz) ➡️ Better Exposure & Easier Extension & Small Size
4. Lower MidLine Abdominal ➡️ When Dx in Doubt & Bowel Obstruction Present
🔶C. Mx Of Appendix Mass ➡️ According To Ochsner Sherren Regime
1. Marks & Follows The Mass Size Using Skin Pencil
2. Give IV Fuids & AB (Cefuroxime 750mg + Metronidazole 500mg)
3. Mostly Mass Resolve in 24-48h (90%) ➡️ Then Do AppendiCectomy After 6w
4. No Mass Resolution ➡️ Suspected Carcinoma Or Crohn's Disease
5. Clinical Deterioration (Mass Developed Abscess) ➡️ Do Laparotomy & Retroperitoneal Abscess Drinage & Appedicectomy
🔹Complications Of Appendicitis
🔶A. Preoperative
📍1. Perforation Of Appendix & Peritonitis Seen More in :
▪︎Extremity Of Ages (Young Child Or Elderly)
▪︎Immunosuppression & DM
▪︎Pelvic Appendix
▪︎Fecolith Obstruction Of Appendix
▪︎Previous Abdominal Surgery
📍2. Appendix Mass Formation (Due To Omental & Small Bowel Adhesions)
📍3. Appendix Abscess
🔶B. Postoperative
📍1. Wound Infection (Most Common Postoperative Complication) ➡️ Pain & Erythema At Wound Site On 4th-5th Day
📍2. Intra-Abdominal Abscess ➡️ Develop 5-7 Days After Operation As Spiking Fever With Malaise & Anorexia
📍3. Paralytic Ileus
📍4. DVT (More in Elderly & Women Taking Contraceptives)
📍5. PyleoPhlebitis (Portal Pyaemia) ➡️ High Fever With Rigor & Jaundice Due To IntraHepatic Abscess Formation
📍6. Faecal Fistula
📍7. Bowel Obstruction Due To Adhesions (Most Common Late Complication)
📍8. Pneumonitis & Lobar Collapse
#Appendicitis
#Surgery
https://t.me/Surgery_Practice
🔶A. Preoperative Preparation
1. Bowel Rest (Nill By Mouth)
2. IV Fluids (To Establish Urine Output)
3. IV AB (Amoxicillin/Metronidazole/3rd G.Cephalosporins Like Ceftriaxone/Ertapenem)
4. Anti-Pyretics If High Temperature Present (Aspirin For Children Or Paracetamol Vial)
🔶B. Surgical AppendiCectomy (Laparoscopic Or Conventional)
▪︎Types Of Incisions During Conventional Surgery
1. Gridiron (Most Commonly Used) ➡️ Made At McBurney's Area
2. Rutherford Morison ➡️ Give Better Access If Appendix in Para Or RetroCaecal Position
3. Transverse (Lanz) ➡️ Better Exposure & Easier Extension & Small Size
4. Lower MidLine Abdominal ➡️ When Dx in Doubt & Bowel Obstruction Present
🔶C. Mx Of Appendix Mass ➡️ According To Ochsner Sherren Regime
1. Marks & Follows The Mass Size Using Skin Pencil
2. Give IV Fuids & AB (Cefuroxime 750mg + Metronidazole 500mg)
3. Mostly Mass Resolve in 24-48h (90%) ➡️ Then Do AppendiCectomy After 6w
4. No Mass Resolution ➡️ Suspected Carcinoma Or Crohn's Disease
5. Clinical Deterioration (Mass Developed Abscess) ➡️ Do Laparotomy & Retroperitoneal Abscess Drinage & Appedicectomy
🔹Complications Of Appendicitis
🔶A. Preoperative
📍1. Perforation Of Appendix & Peritonitis Seen More in :
▪︎Extremity Of Ages (Young Child Or Elderly)
▪︎Immunosuppression & DM
▪︎Pelvic Appendix
▪︎Fecolith Obstruction Of Appendix
▪︎Previous Abdominal Surgery
📍2. Appendix Mass Formation (Due To Omental & Small Bowel Adhesions)
📍3. Appendix Abscess
🔶B. Postoperative
📍1. Wound Infection (Most Common Postoperative Complication) ➡️ Pain & Erythema At Wound Site On 4th-5th Day
📍2. Intra-Abdominal Abscess ➡️ Develop 5-7 Days After Operation As Spiking Fever With Malaise & Anorexia
📍3. Paralytic Ileus
📍4. DVT (More in Elderly & Women Taking Contraceptives)
📍5. PyleoPhlebitis (Portal Pyaemia) ➡️ High Fever With Rigor & Jaundice Due To IntraHepatic Abscess Formation
📍6. Faecal Fistula
📍7. Bowel Obstruction Due To Adhesions (Most Common Late Complication)
📍8. Pneumonitis & Lobar Collapse
#Appendicitis
#Surgery
https://t.me/Surgery_Practice
Telegram
Surgical Practice Dr. alqhatani
- تابعة لقناة معلومات طبية:
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
❤4
❤3
🔴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
#Cholecystitis part1
#Surgery
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
#Cholecystitis part1
#Surgery
https://t.me/Surgery_Practice
Telegram
Surgical Practice Dr. alqhatani
- تابعة لقناة معلومات طبية:
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫
👍1
🔹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
#Cholecystitis part2
#Surgery
https://t.me/Surgery_Practice
🔸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
#Cholecystitis part2
#Surgery
https://t.me/Surgery_Practice
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@M_Information11
- قروب للمناقشة الطبية:
@M_Information21
- بوت التواصل :
@Alqhatani_bot
- صارحني :
http://t.me/SY8Bot?start=wiRwSie0ew
🚫 نحلل النقل ولا نحلل حذف الروابط🚫