Surgical notes
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" Adenoid "

🔸Dif. Hypertrophy of subepithelial lymphoid tissue of nasopharynx

🔸Aetiology :
-reccurent Rhinitis ,sinusitis ,tonsilitis
-allergy of the URT

🔸C/P

♦️Nasal symptoms:

-Nasal obstraction (MC)>>mouth breathing >>interferes with feeding or suckling > fails to thrive
-Snoring , sleep apnae
-Nasal discharge > wet bubbly nos
-Sinusitis
-Epistaxis
-Voice change > rhinolalia clausa

♦️Aural symptoms :

-Tubal obstraction > retracted drum >CHL
-recurrent atack of AOM ( Aotalgia)
-chronic suppurative OM
-Serous OM

♦️General

🔹Adenoid facies
Deu to prolonged mouth breathing >

-Enlarged face with dull expression
-Open mouth
-Prominent and crowded upper teeth
-Elevated upper lip
-Receding lowe jaw
-Pinched nostril
-High arched Hard palate

🔹pulmonary HTN > cor pulmonale
🔹Aprosexia ( lack of concentration)


🔸manegment

🔹mild case >medical as
Decongestant nasal drop , anti histamine ,treat infection > cure
🔹marked symptoms > adenoidoctomy


#ENT
🦉Hyponasality (Rhinolalia cluasa) It is lack of nasal resonance for words which are resonated in the nasal cavity, e.g. m, n, ng.
It is due to blockage of the nose or nasopharynx.

🦉Hypernasality (Rhinolalia aperta)
It is seen when certain words which have little nasal resonance are resonated through nose. The defect is in failure of the nasopharynx to cut off from oropharynx or abnormal
communication between the oral and nasal cavities.


#ENT
Ménière's Disease




#ENT
🟢Recurrent Neisseria infections ,
manifesting as recurrent meningitis

✔️Think of Complment deficiency,

🔻In yemen, Twice infection of Neisseria, Meningitis give prophylactic long-acting penicillin .

د. احلام المرتضى

#باطنة
◽️When patient having immune deficiency:-

Immunoglobulin deficiency ( B-cell ) never give Vaccination ( Not helpful)

Complement deficiency we can give Vaccination for Prophylaction

د. احلام المرتضى

#Immunity
#باطنة
🟡 HLA gene coding for MHC receptors on the Surface of the Cell

MHC1 ( APC ) >> CD8 ( T-Cytotoxic )

لو مش موجود MHC1 الخاص بخلايا الجسم
تقوم خلية T Cytotoxic بمهاجمة الخلية

MHC 2 ( APC ) >> CD4 ( T- Helper Cell)

هنا يقوم بتقديم ال Antigen لل T- Helper

#Immunity
#باطنة
🛑Complement is considered as Innate Immunity ..

🛑 the first response is By Neutrophils
But it's week calling Macrophage forzdx Help

🛑 Macrophage is Slower but Stronger
And It Introduce the Antigen for The Adaptive Immunity " Antigen Presenting Cell "

#Immunity
#باطنة
For screening Complement Immune deficiency:-

♦️The CH50 (classical haemolytic pathway 50) for Classical pathway


♦️alternative pathway function (AP50).


♦️Level of C3 and C4 but not accurate

#Immunity
#باطنة
🛑 danazol and oxandrolone :-

can help reduce the chances of swelling occurring if you have hereditary angioedema.

It happened due to C1 esterase inhibitor deficiency in blood.

#Immunity
#باطنة .
🟡 Most common immunodeficiency is

Selective IgA deficiency

#Immunity
#باطنة
🔴 one of the causes of secondary Immune deficiency is:-

Measels and more important Leishmaniasis

#باطنة
#Immunity
🔵 Very important in Old age and the immune deficiency symptoms of infection is Atypical

that's mean no fever and other clinical features of that infection..

In Old age Patiet Always think Of Two :-

-Respiratory tract infection or Urosepsis

#Immunity
#باطنة
🟣 Warning signs of immune deficiency:

- more than 4 respiratory tract infections per year in an adult

-More than 1 infection requiring hospitalization

-Infection with unusual organism

-Infection at an unusual site

-Chronic infection unresponsive to usual treatment

-Early end organ damage ( e.g. bronchiectasis)

-Family history of immune deficiency

#Immunity
#باطنة
Nasopharyngeal Cancer



#ENT
Rheumatoid Arthritis


#باطنة
Dermatomyositis



#باطنة