👆امسكيوهات للنقاط المهمة في موضوع ⬇️
Breast #Cancer

#بالتوفيق
@Surgery_Practice

لما أفكر أؤلف مرجع في الجراحة 😁

🔴Hydatid Liver Disease

▪︎Liver Infection Caused By The Tapeworm (Echinococcus Granulosus Or Multinodularis) That Lives in Dog's Bowel Then Pass To (Cattle & Sheep & Goats & Camels) Then Ingested By The Humans To Pass Through The Portal Blood To The Liver

▪︎Results in Slow Growing Liver Cyst (Infection From Childhood Then Symptoms At Adulthood)

▪︎Common in Middle East (Specially Near Farms مناطق ريفية ومزارعين)

▪︎Liver Most Commonly Involved (Mostly Invade The Right Lobe Of The Liver)

▪︎Lung 2nd Most commonly involved (Mostly Invade Lower Right Lobes)

▪︎Can Invade Any Other Organs (Brain/Pancreas/Adrenals)

🔹Cyst Structure
📍1. Pericyst (Adventitia) ➡️ The Outer Wall Of The Cyst That Formed Due To Inflammatory Reaction To The Parasite

📍2. Laminated Membrane (Ectocyst) ➡️ The Middle Layer Of The Cyst

📍3. Inner Germinal Layer (EndoCyst) ➡️ The Internal Layer Of The Cyst That Contains Viable Parasites & Gives The Daughter Cysts Or Brood Capsule (That Gives ProtoScolices)


🔹Cyst Classification
📍1. Active Group ➡️ Cyst >2cm & Fertile

📍2. Transition Group ➡️ Cyst Start To Degenerate Due To Tx Or Host Immunity

📍3. Inactive Group ➡️ Degenerated & Partially Or Totally Calcified Cyst


🔹Clinical Features & Complications
1. Asymptomatic

2. Chronic Dull RUQ Pain (Due To Stretching Of Liver Capsule)

3. Gradually Enlarging Painful Mass in RUQ

4. Severe Abdominal Pain & Peritonitis After Minor Trauma (Due To Cyst Rupture)

5. Anaphylactic Shock (Due To Cyst Rupture)

6. Obstructive Jaundice Or Acute Cholangitis (Due To Cyst Communication Or Rupture into The Biliary Tree)

7. Liver Abscess

8. Pulmonary Symptoms
▪︎Dyspnea
▪︎Coughing White Material
▪︎Chest Pain
▪︎Haemoptysis
▪︎Fever
▪︎Pleural Effusion
▪︎Empyema (Pus in Pleural Cavity)

9. CNS Symptoms
▪︎Unexplained Headache Or Features Of Raised ICP


🔹Dx Of Hydatid
📍1. Clinical Features

📍2. CBC ➡️ Eosinophilia

📍3. Serology (ELISA & Complement Fixation) ➡️ +Ve in 70-90%

📍4. Chest Xray ➡️ Large Thin Walled Cavity Containing Floating Membrane (Water Lily's Sign)

📍5. US ➡️ Multi-Loculated Cyst

📍6. CT (Best) ➡️ Floating Membrane Within The Cyst (Water Lily's Sign)


🔹Mx Of Hydatid
🔶A. Start First Medical Tx
📍1. Albendazole (400mg 2x Daily For 3m)

📍2. Mebendazole

📍3. Praziquantel (20mg/Kg 2x Daily For 14 Days)


🔶B. Then Do Surgical Tx
📍1. Percutaneous Tx (PAIR) ➡️ Done Only If There's No Communication With Biliary Tree
▪︎Cyst Puncture
▪︎Then Content Aspiration
▪︎Then HyperTonic Saline Installation
▪︎Then ReAbsorption

📍2. Liver Lobe Resection (SegmentEctomy)

📍3. Local Cyst Excision (PeriCyctEctomy) With Omentoplasty

📍4. Cyst Deroofing & Evacuation Of The Content

اتطلعوا على التعليقات أسفل المنشور ⬇️

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

بالنسبة لامتحان التكميلي قالوا جابه لهم من المطري القديم.

معلومة مهمة كتبتها لكم ولازم تكون في بالكم لأن ممكن تقابلوها في حياتكم العملية:

تخيّل تجي لعندك مريضة عمرها بالثلاثينات تشتكي من ألم صدري حاد مفاجئ مع ضيق بالنفس والأغرب أثناء اخذ القصة المرضية وجدت أن الأعراض تتكرر كل شهر تقريبا!

❗️هذه الحالة تُسمى: Catamenial Pneumothorax

📌 التعريف: هو استرواح صدر عفوي متكرر يحدث عند النساء، ويكون مرتبط زمنياً مع الدورة الشهرية.

⏱️ التوقيت: غالبا خلال 24–72 ساعة من بداية الدورة. وقد يحدث قبلها أو بعدها بقليل (ضمن عدة أيام)

🔁 أهم نقطة للتشخيص:
التشخيص يتطلب تكرار الحالة (على الأقل نوبتين)، لذلك التكرار شرط أساسي لتعريف الحالة.

👩‍⚕️ الفئة الأكثر إصابة: مابين عمر 30–40 سنة. غالبا تجد معهم تاريخ مرضي لبطانة الرحم المهاجرة (Endometriosis)

🫁 السبب: يرتبط بوجود Endometriosis في الصدر (Thoracic endometriosis) مما يؤدي إلى دخول الهواء وحدوث الاسترواح

❇️ ملاحظة مهمة : غالبا يكون في الجهة اليمنى (أكثر من 85%)

❇️ التشخيص: يعتمد على القصة المرضية (العلاقة مع الدورة + التكرار) وتأكيده يكون عبر Thoracoscopy (VATS)

💡 الخلاصة: أي امرأة عندها ضيق بالنفس مع الم في الصدر متكرر ومرتبط بالدورة الشهرية ⬅️ فكر مباشرة في Catamenial Pneumothorax

#surgery
https://t.me/Surgery_Practice

🔴 SEPTIC SHOCK

🔷 Definition: is a severe and life-threatening subset of sepsis characterized by profound circulatory and cellular/metabolic dysfunction associated with a high risk of mortality.


🔷 Pathophysiology Septic shock results from a dysregulated host response to infection leading to:
▪︎ Release of inflammatory mediators (cytokine storm)
▪︎ Widespread endothelial injury → capillary leakage
▪︎ Systemic vasodilation → relative hypovolemia
▪︎ Microcirculatory dysfunction
▪︎ Activation of coagulation pathways → DIC
▪︎ Impaired tissue perfusion → cellular hypoxia → multi-organ failure


🔷 Clinical features:
❇️ EARLY (HYPERDYNAMIC / “WARM SHOCK”)
▪︎ Fever or hypothermia
▪︎ Tachycardia
▪︎ Tachypnea
▪︎ Warm flushed skin
▪︎ Wide pulse pressure
▪︎ Bounding pulses
▪︎ Normal or high cardiac output (initial phase)
▪︎ Hypotension may still be compensated

❇️ LATE (HYPODYNAMIC / “COLD SHOCK”)
▪︎ Severe hypotension
▪︎ Cold clammy extremities
▪︎ Poor peripheral perfusion
▪︎ Mottled skin / cyanosis
▪︎ Altered mental status
▪︎ Oliguria
▪︎ Narrow pulse pressure
▪︎ Multi-organ dysfunction

⚠️ KEY POINT Septic shock is a dynamic process: 👉 starts hyperdynamic
👉 progresses to hypodynamic if untreated


🔷 DIAGNOSTIC CRITERIA :
  ✔️ Suspected or confirmed infection
✔️  Vasopressor requirement to maintain MAP ≥ 65 mmHg
✔️ Serum lactate > 2 mmol/L Despite adequate fluid resuscitation

🔷 Management⏱️ Time-critical emergency (golden hour):

1️⃣ Early aggressive IV fluids (crystalloids 20–30 mL/kg)

2️⃣ Broad-spectrum IV antibiotics within 1 hour

3️⃣ Vasopressors (first-line: norepinephrine) to maintain MAP ≥ 65 mmHg

4️⃣ Oxygen therapy ± mechanical ventilation if needed

5️⃣ Source control (drainage / surgery / remove infected focus)

6️⃣ Adjuncts: vasopressin, inotropes (dobutamine), steroids in refractory shock

⚠️ Key Point Septic shock carries a very high mortality rate and requires immediate ICU-level resuscitation and continuous monitoring

#surgery
https://t.me/Surgery_Practice