✅Cholecystitis 
is inflammation of the gallbladder after Blockage mostly by Stones


💢Symptoms
▪︎right upper abdominal pain
▪︎pain in the right shoulder
▪︎nausea, vomiting
▪︎fever
▪︎gallbladder attacks (biliary colic) precede acute cholecystitis.

▪︎Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes severe pain (Murphy's sign).

▪︎The pain lasts longer in cholecystitis than in a typical gallbladder attack.


💢Risk Factors
▪︎Birth control pills (Estrogen)
▪︎pregnancy
▪︎family history
▪︎obesity
▪︎diabetes
▪︎liver disease
▪︎rapid weight loss
▪︎diet high in fat and cholesterol


💢Complications Of Acute Cholecystitis
▪︎Gangrene Of Gallbladder
▪︎Gallbladder rupture
▪︎Empyema
▪︎Fistula formation


💢Gallstones Complications
▪︎Acute Pancreatitis
▪︎Acute Cholecystitis
▪︎Acute Cholangitis
▪︎Obstructive Jaundice
▪︎Gallbladder Ileus

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■DDX OF NECK MASSES

❇️Multiple lumps: are invariably lymph glands.

❇️A single lump: 👇

♦️In the anterior triangle that does not move with swallowing:

▪︎Solid: Lymph gland, Carotid body tumor.
▪︎Cystic: Cold abscess, Branchial cyst.


♦️In the posterior triangle that does not move with swallowing:

▪︎Solid: Lymph gland.
▪︎Cystic: Cystic hygroma, Pharyngeal pouch, occasionally a secondary deposit of a papillary thyroid carcinoma
▪︎Pulsatile: Subclavian aneurysm.


♦️In the anterior triangle that moves with swallowing:

▪︎Solid: Thyroid gland, Thyroid isthmus lymph gland.
▪︎Cystic: Thyroglossal cyst.

#Neck_Swelling
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✅Notes on Neck Mass

⬇️ Ask the patient to swallow some water and observe the movement of the mass:

▪︎Thyroid gland masses (e.g. a goitre) and thyroglossal cysts typically move upwards with swallowing.

▪︎Lymph nodes will typically move very little with swallowing.

▪︎An invasive thyroid malignancy may not move with swallowing if tethered to surrounding tissue.


⬇️ Ask the patient to protrude their tongue:

▪︎Thyroglossal cysts will move upwards during tongue protrusion.

▪︎Thyroid gland masses and lymph nodes will not move during tongue protrusion.

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#Surgery_rotation
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#How to take history in common surgery cases
#DDX
#Examination
#Instrument
#Discussion

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❇️Appendicitis
is inflammation of the Appendix Mostly by obstruction of the opening of the appendix, as a result of either a faecolith (hardened stool) or lymphoid hyperplasia

🔹Typical symptoms:
▪︎Nausea and vomiting
▪︎Low-grade fever
▪︎Migratory abdominal pain ( staring as Umbilical pain then shifting to
Right iliac fossa pain)
▪︎Diarrhoea
▪︎Anorexia & Loss Appetite

🔹Typical clinical findings:
▪︎Right iliac fossa tenderness
▪︎Shifting (Migratory) Pain
▪︎Rebound Pain
▪︎Leucocytosis

▪︎Rovsing sign: palpation of the left iliac fossa causes right iliac fossa pain

▪︎Psoas sign: extension of the right thigh, in the left lateral position, causes right iliac fossa pain

▪︎Obturator sign: internal rotation of the flexed right thigh causes pain

▪︎Hop test: hopping or jumping causes abdominal pain

🔹If there is a delay in presentation with appendicitis, complications can include:

▪︎Perforation & peritonitis
▪︎Abscess formation
▪︎Appendicular Mass

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❇️Migration of pain in appendicitis

▪︎Initial inflammation stimulates visceral afferent pain fibres which correspond to the T10 dermatome, producing umbilical pain. (Not Specific/Not Localized Pain)

▪︎As the appendix becomes more inflamed, it irritates the parietal peritoneum which activates somatic nerve fibres and produces localised pain which is most often felt in the right iliac fossa. (Localized Specific Pain)

▪︎Visceral Pain ➡️ Parietal (Somatic) Pain

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🔥Postoperative Fever in days

#Postoperative complications
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💢After Operation In each Day Ask about

▪︎When regain Consciousness
▪︎When start oral intake
▪︎When pass Fecess/Flatus
▪︎Urine Output
▪︎Movement
▪︎Nausea & Vomiting
▪︎Cough/Sputum
▪︎Dyspnea/Chest pain
▪︎Surgical Site pain
▪︎Leg Pain
▪︎Bleeding & Wound Discharge
▪︎Fever
▪︎Drains & Catheters (Amount/Color/Tenderness)
▪︎Drugs And treatment Received



#Postoperative complications
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💢Hemorrhoids (piles)
are swollen veins in The anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

💢Hemorrhoids can develop from increased pressure in the lower rectum due to:

▪︎Straining during bowel movements
▪︎Sitting for long periods of time
▪︎chronic diarrhea or
constipation
▪︎Obesity
▪︎pregnancy
▪︎Eating a low-fiber diet
▪︎Regular heavy lifting

💢Most important Symptom
▪︎Blood After Defecation

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💢Rectal Bleeding

🔹History
▪︎Has the patient ever passed any blood in the stool?

▪︎Was it bright or dark?

▪︎How much?

▪︎Was it mixed in with or on the surface of the stool, or did it only appear after the stool had been passed?


🔹All rectal bleeding must be taken seriously and investigated with sigmoidoscopy


🔹The commonest cause of rectal bleeding is piles (Hemorrhoids)


🔹Patients with rectal cancer usually have multiple symptoms. One of the commonest is rectal bleeding, usually a small amount of dark-red blood streaked on the stool


#Rectal Bleeding
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Macleod's Clinical Examination15th Edition 2024
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