Clinical manifestations of necrotizing infection include :

●Erythema (without sharp margins )

●Edema that extends beyond the visible erythema .

●Severe pain (out of proportion to exam findings in some cases

●Fever

●Crepitus

●Skin bullae ( Heamorrhagic ), necrosis, or ecchymosis

Fever ,tachycardia, and systemic toxicity may be observed.

Hypotension may be present initially or develop with progressive infection.

Other symptoms include malaise, myalgias, diarrhea, and anorexia.

The subcutaneous tissue may be firm and indurated, such that the underlying muscle groups cannot be palpated distinctly.

Marked edema may produce a compartment syndrome with complicating myonecrosis requiring fasciotomy.

diminished sensation to pain develops in the involved area, due to thrombosis of small blood vessels and destruction of superficial nerves in the subcutaneous tissue.

#جراحة

Biliary cysts are associated with an increased risk of cancer, particularly cholangiocarcinoma , but also pancreatic and gallbladder cancers. Cancer is more common in patients who are older and in those with type I and IV cysts.

Because of the increased risk of malignancy, it is recommended that patients with type I or IV cysts have the cysts completely removed with Roux-en-Y hepaticojejunostomy.

The risk of cancer appears to be lower in patients with type II or III cysts.

Patients with type II cysts can often be treated with simple cyst excision, while those with type III cysts can be treated with sphincterotomy or endoscopic resection

Patients with type V cysts have a moderate risk of cancer, but because of the intrahepatic nature of the cysts, treatment can be difficult and some patients require liver transplantation


#جراحة

Courvoisier 's low

#جراحة

Stages of Ulcer

#جراحة

Abdominal x-ray anatomy

#اشعة
#جراحة

Cough medications | Pediatric | ٲدوية السعال في الٲطفال,  الٲصناف المتوفرة والجرع الآمنة PDF

You Tube
https://youtu.be/0HO0ETS5Ns0?si=rVQoGQ9TSIfU4MiD


Telegram
https://t.me/generalprac123

Paracetamol , Albendazole, Mebendazole  | ٲدوية عيادات الٲطفال بالجرع الصحيحة PDF



You Tube
https://youtu.be/d-9WfQKSNRU?si=UFXBhF-952qjla_q


Telegram
https://t.me/generalprac123

KCL postassoum chloride ,Rapid correction of hypokalemia   |  ٲدوية طوارئ الٲطفال بالجرع الصحيحة PDF

You Tube
https://youtu.be/0PEO_BDPZ1E

Telegram
https://t.me/generalprac123

Croup Management | pediatric | كيفية التعامل مع حالات الخناق الفيروسي في الطوارئ PDF


You Tube
https://youtu.be/fYa7DBxvZ9w?si=Vtm7j5h0tO-Et_uy

Telegram
https://t.me/generalprac123

🔵NF :

-Pain disproportionate to physical finding

-Rapidly spread  " serious disease"

- Cardinal features during examination:-  signs of Inflammation  + crepitus " gass forming bacteria " , Echymosia or necrosis ,  bullae " hemorrhagic ".

- Do the finger test .

- Dishwater fluid ( discharge) is when the fluid inside the tissues turns a grey, murky colour , offensive odour


- Patient may present in Shock state.

- Ludwig's angina and NF are extensive manifestations of soft tissue infection to occur in the cervico-facial region. 

-Fournier gangrene is a type of necrotizing fasciitis or gangrene affecting the external genitalia or perineum. 

🔹Investigations :-

CBC :
⬆️ WBCs

Electrolytes :
⬇️ Na

RFT , KFT :
⬆️Urea
⬆️ Creatinine


🔷 May be appear in x-ray:

Early findings are non-specific, similar to those of cellulitis, such as increased soft-tissue thickness and opacity. Soft tissue gas is seen in only a minority of cases.


🔷Treatment:

- Resuscitation
- Wide Aggressive surgical debridement
- Wide spectrum antibiotics
Should cover Gram +ve and -ve , aerobic and anaerobic bacteria
Such as :
- Vancomycin for MERSA
-  Metronidazole ir clindamycin for anaerobic bacteria
- Amikacin ( * normal creatinine) or levofloxacin for gram -ve
- may be Carbapenems : such as imipenem-cilastatin, meropenem

#جراحة

Types of NF .

#جراحة

Finger test in NF

#جراحة

Management depends on stage ( Classification)

#جراحة

The puncture, aspiration, injection, and reaspiration (PAIR) technique, which involves puncture of the cyst wall, aspiration of cyst contents, instillation, and reaspiration of the scolicidal agent, has gained international recognition

#جراحة