Act as a Surgeon 🧠🔪

History taking of diabetic foot.

🤍🕊️✨ فِي هَذِهِ اللَّيْلَةِ الْمُبَارَكَةِ، لَيْلَةِ الْجُمُعَةِ، أَكْثِرُوا مِنْ ذِكْرِ اللهِ، وَمِنَ الصَّلَاةِ عَلَى الْحَبِيبِ الْمُصْطَفَى صَلَّى اللهُ عَلَيْهِ وَعَلَى آلِهِ الطَّاهِرِينَ، فَمَا مِنْ مُسْلِمٍ يُصَلِّي عَلَيْهِ صَلَاةً إِلَّا صَلَّى اللهُ بِهَا عَلَيْهِ عَشْرًا. اللَّهُمَّ صَلِّ عَلَى سَيِّدِنَا مُحَمَّدٍ وَآلِ مُحَمَّدٍ. 🤍🕊️✨ #نفحات_إيمانية

#GRED@Clinicalsurgeryround

🔹Mx Of GERD 🔶A. Life Style Changes 📍1. Weight Loss 📍2. Stop Smoking/Coffee/Tea 📍3. Stop Heavy Meals At Night 📍4. Head Elevation During Sleep 🔶B. Medications 📍1. Start Long Term PPI For 8 Weeks (Then Decrease The Dose To Keep The Patient Free Of Symptoms) 📍2. If No Response ➡️ Increase Dose Of PPI Or Add H2-Blockers Or Antacids 🔶C. Endoscopic Tx To Augment LOS 📍1. Radiofrequency Ablation Of LOS (RFA) ➡️ Effective Procedure As Long As 10 Years 📍2. Endoscopic Suturing Devices 📍3. SubMucosal Injection Of Polymers Into The LOS 🔶D. Surgical Tx (Laparoscopic Fundoplication) ▪︎Reducing Hiatus Hernia if Present ▪︎Approximate The Crura Around The Lower Esophagus ▪︎Wrap The Upper Stomach Around The Esophagus (Total Nissen Or Partial Toupet Or Watson Fundoplication) ▪︎Indications For Surgery 1. Patient Choice in Uncomplicated GERD 2. No Improvement On PPI 3. Poor Compliance To Medications Due To Side Effects 4. High Volume Alkaline Reflux 5. Hermit Life Style (Means Any Small Deviation From Strict Life Style Leads To Recurrent Of The Symptoms) بس شوية يخرب الدايت تنلاص عليه 6. Psychological Distress From The Symptoms 7. Complications Develop 🔹Complications Of GERD 🔶A. Preoperative 📍1. Benign Esophageal Strictures ▪︎More in Middle Age & Elderly With Long Standing GERD ▪︎Immediately Above The Gastroesophageal Junction ▪︎1-2cm & Smooth Mucosa ▪︎Good Response To PPI & Dilatation 📍2. Shortening Of Esophagus ➡️ Due To Hiatus Hernia Or Esophageal Wall Fibrosis 📍3. Reflux Esophagitis 📍4. Barrett's Esophagus (Intestinal Metaplasia) ▪︎Metaplastic Changes in Lower Part Of Esophagus From Squamous To Columnar Epithelium in Response To Chronic GERD ▪︎Risk Of Adenocarcinoma (0.5%) ▪︎Need Endoscopic Follow Up Every 2 Years ▪︎Mx Of Barrett's Esophagus 1. Treat GERD (PPI Or Fundoplication) 2. Endoscopic Mucosal Resection (EMR) + Radiofrequency Ablation 📍5. Gastric Volvulus 📍6. Anemia 🔶B. Postoperative (After Fundoplication) 📍1. Gas Bloating (Not Able To Belch) 📍2. Dysphagia 📍3. Early Satiety & Excessive Flatus 📍4. Recurrent GERD

🔴Gastroesophageal Reflux Disease (GERD) Excessive Pathological Reflux (Entrance) Of Gastric Acid Into The Esophagus That Causing Symptoms & Complications Due To Loss Of LOS Competence ▪︎More in Middle Age Males 🔹Risk Factors & Causes Of GERD 📍1. Repetitive Physiological Transient Relaxation Of LOS During Swallowing Or Vomiting Or After Meal 📍2. Decrease LOS Tone Due To ▪︎Alcohol & Smoking ▪︎Food (Fat/Chocolate/Caffeine/Tea) ▪︎After Surgical Dilatation Of LOS ▪︎Peptic Strictures ▪︎Idiopathic ▪︎Drugs (CCB/TCA/NSAIDS/Benzodiazepines/Morphine/Diazepam/Dopamine/Beta Agonist/Anticholinergic/Alpha Blockers/Glucagon/Progesterone) 📍3. Increase Intra-Abdominal Pressure Due To ▪︎Obesity & Pregnancy ▪︎Coughing & Straining 📍4. Large Meals & Delayed Gastric Emptying 📍5. Hiatus Hernia (Upper Stomach Herniation Into The Thoracic Through The Diaphragm) 📍6. Delayed Esophageal Clearance (Defective Peristalsis) Due To Esophagitis 🔹Clinical Features Of GERD 📍1. Start As Regurgitation (Passive Reflux Of Gastric Content Into The Esophagus & Mouth Without Preceding Nausea) 📍2. Then Develop Retrosternal Chest (HeartBurn) Or Epigastric Pain ▪︎Aggravated By Eating Spicy & Fatty Meals (Delayed Gastric Emptying) & After Stooping (Bending Or Lying Down Or Supine Position) & Exercise ▪︎Relived Partially By Drugs (PPI/Antacids) & Sitting Position ▪︎SomeTimes The Pain Radiate To Back ▪︎Symptoms More At Night 📍3. Unpleasant Taste in Mouth (Metallic Or Bitter Or Acid Taste Due To Gastric Juice Reflux Into The Mouth) 📍4. Increase Mouth Salivation (WaterBrash Due To Acid Reflux Stimulates Salivary Glands) 📍5. Painful Swallowing (OdynoPhagia Due To Esophageal Inflammation) 📍6. Difficulty Swallowing (Dysphagia Due To Development Of Esophageal Strictures) 📍7. Patient Waking At Night Choking (Acid Reflux Irritate The Larynx) & Voice Hoarseness (Acid Laryngitis) 📍8. Recurrent Chest Infections & Chronic Cough & Asthma 🔹Dx Of GERD 📍1. Clinical Features 📍2. Endoscopy With Biopsy ▪︎To See ➡️ Esophagitis/Peptic Strictures/Barrett's Esophagus/Hiatus Hernia ▪︎Indicated Only If Alarming Features Present ➡️ Old Age (55 Years) With Dysphagia/Weight Loss/Anorexia/Anemia/Melaena Or Haematemesis/Recent Onset Progressive Symptoms 📍3. 24h Ph Monitoring (Gold Standard) & Esophageal ManoMetry ➡️ When AntiReflux Surgery is Planned

Stomach and duodenum

Topic of tonight is #Achalasia@Clinicalsurgeryround

🔴Achalasia ▪︎Failure Relaxation Of Lower Esophageal Sphincter (LOS) Due To Selective Loss Of Inhibitory Neurons in The Lower Esophagus (Loss Of Ganglionic Cells From Myenteric Auerbach's Plexus) With Absent Peristalsis in Body Of Esophagus ▪︎Most Common Esophageal Motility Disorder ▪︎Idiopathic Aetiology ▪︎More in Middle Age Females (30-40 Years) 🔹Clinical Features Of Achalasia 📍1. Start As Slowly Progressive Dysphagia (1st For Solids Then For Fluids) 📍2. Frequent Regurgitation Of Undigested Food 📍3. Halitosis (Bad Mouth Odour) 📍4. Weight Loss 📍5. Recurrent Chest Infections & Night Cough (Due To Food Aspiration) 📍6. Retrosternal Chest Pain That Decrease in Severity Later (Esophageal Peristalsis Diminished Over Time) 🔹DDX Of Achalasia 1. Chagas Disease ➡️ Chronic Infection With Trypanosoma Cruzi Results in Degeneration Of Myenteric Plexus 2. PseudoAchalasia ➡️ Malignant Tumors Of GIT (Adenocarcinoma Of Cardia/Pancreatic Tumors) & Bronchial Tumors Can Cause Obstruction At Lower Esophageal Sphincter 🔹Dx Of Achalasia 📍1. Endoscopy ➡️ Tight LOS & Food Residues in The Esophagus 📍2. Barium Swallow ➡️ Proximal Esophageal Dilatation With Distal Smooth Narrowing (Inverted Bird Beak Or Rat Tail Shape) 📍3. Esophageal ManoMetry (HRM Gold Standard) ▪︎No Relaxation Of LOS On Swallowing ▪︎No Esophageal Body Peristalsis ▪︎Raise in Esophageal Resting Pressure 🔹Mx Of Achalasia 📍1. Pneumatic Dilatation (75-85% Successful) ➡️ Using Plastic Balloon To Stretch & Dilates The LOS Gradually Over Weeks 📍2. Heller's MyoTomy (90% Successful) With Partial Anterior Fundoplication ➡️ Cutting The Muscle Of LOS & Cardia 📍3. Pre-Oral Endoscopic MyoTomy (POEM) ➡️ Creating SubMucosal Tunnel in Middle Part Of Esophagus 📍4. Endoscopic Injection Of Botox Into The LOS ➡️ Results in Transient Relaxation Of LOS & Need To Be Repeated Every Months 📍5. CCB (SubLingual Nifedipine) ➡️ Transient Symptomatic Relief Until Definitive Tx Done 🔹Complications Of Achalasia 🔶A. Preoperative 📍1. Aspiration Pneumonia 📍2. Esophageal Cancer (Squamous Carcinoma Of Esophagus) 🔶B. Postoperative 📍1. Perforation Of Esophagus (After Pneumatic Dilatation) 📍2. GERD (After Heller's MyoTomy) 📍3. Failed Dilatation Or Recurrent Stenosis 🔴Diffuse Esophageal Spasm (Jackhammer Or Nutcracker Or HyperContractile Esophagus) ▪︎incoordinated & Irregular Repetitive Esophageal Spasms (Peristalsis) More in Distal ⅔ Of Esophageal Body ▪︎More in Middle Age & Elderly Males ▪︎Idiopathic Aetiology 🔹Clinical Features 📍1. Intermittent Dysphagia 📍2. Acute Retrosternal Chest Pain Induced By Eating (DDX Angina) 🔹Dx 📍1. Barium Swallow ➡️ Corkscrew Shape Of Esophagus (Due To incoordinated Diffuse Contraction) 📍2. Esophageal ManoMetry ➡️ Diffuse HyperTonicity (400-500mmHg) & incoordinated Peristalsis During The Attack (Normal Peristalsis If No Attack Present) 📍3. Endoscopy & Biopsy ➡️ Hypertrophy Of Esophageal Circular Muscles 🔹Mx 📍A. Medical ▪︎CCB ▪︎SubLingual Nitrate ▪︎PPI 📍B. Surgical ▪︎Esophageal Endoscopic Dilatation ▪︎Long MyoTomy

#Angiodysplasia@Clinicalsurgeryround.

Topic of tonight are #Mesenteric_Ischemia@Clinicalsurgeryround.

🔴Vascular Diseases Of The Bowel 🔰Angiodysplasia ▪︎Abnormally Tortuous Dilated Small Veins In Mucosa & Submucosa Of The Right Colon (Vascular Malformation) ▪︎Mostly Multiple & Involve The Caecum Or Ascending Colon ▪︎Unknown Aetiology ▪︎Could Be Associated With Aortic Stenosis (Heyde's Syndrome) ▪︎2nd Most Common Cause Of Severe GIT Bleeding in Elderly (60 Years Age) After The Diverticulae 🔹Clinical Features Of Angiodysplasia 📍1. Anemia (Most Common) 📍2. Severe Rectal Bleeding Or Melena (10-15%) 🔹Dx Of Angiodysplasia 📍1. +Ve Fecal Occult Blood Test 📍2. Colonoscopy (Gold Standard) ➡️ Seen As Small Red Raised Area 📍3. Angiography Of The Mesenteric Arteries (Dx & Tx) ➡️ Seen As Blue Contrast (If There's Bleeding > 1ml/Minute) 📍4. Technetium-⁹⁹m Labelled RBCS Scan 📍5. CT Angiography 🔹Mx Of Angiodysplasia 📍1. Patient Stabilization ➡️ Blood Transfusion in Severe Anemia Or Continuous Bleeding 📍2. Endoscopic Cauterization Of Bleeding Site 📍3. Angiography & Embolization 📍4. Surgical Resection Of Affected Bowel Segment ➡️ If Bleeding Site Can't Be Localized Or Not Response To Previous Measures 📍5. Bleeding From Multiple Or Inaccessible Sites ➡️ Give (Tranexamic Acid/AminoCaproic Acid/Estrogen) To induce Coagulation & Decrease The Bleeding

🔰Mesenteric Ischaemia ▪︎Acute Or Chronic Decrease in The Blood Supply To The Bowel Results in Bowel Ischaemia Then Hemorrhagic Infarction Then Gangrene & Perforation ▪︎High Mortality (70-90%) ▪︎Acute Cases Mostly Due To Thrombosis Or Embolization Of Superior Mesenteric Vessels ▪︎Inferior Mesenteric Ischaemia Usually Silent Due To Good Collateral Circulation ▪︎Chronic Cases Mostly Due To Generalised Atherosclerosis Of Mesenteric Vessels ▪︎The Time Limit For The Bowel Before Infarction is About 3h 🔹Causes & Risk Factors Of Ischaemia 1. Atrial Fibrillation 2. Mural Myocardial Infarction 3. Mitral & Aortic Valve Vegetation (Endocarditis) 4. Atheromatous Plaques From Aortic Aneurysm 5. Generalised Atherosclerosis 6. Vasculitis (ThromboAngitis Obliterans & Polyarteritis Nodosa) 7. Factor V Leiden (Coagulation Disorder) 8. Portal Hypertension & Portal Pyaemia 9. Sickle Cell Anemia & Polycythemia & DIC 10. Oral Contraceptives 11. Dehydration & Shock (Hypoperfusion) 🔹Clinical Features Of Bowel Ischaemia 🔶A. Acute Ischaemia 📍1. Sudden Onset Of Severe Constant Colicky Abdominal Pain in Patient With AF Or Atherosclerosis ▪︎Central Abdominal Pain ➡️ Small Bowel Ischaemia ▪︎Lower Left Abdominal Pain ➡️ Large Bowel Ischaemia (Ischemic Colitis) 👇 ▪︎Colonic Ischaemia is More At The Left Colon (Splenic Flexure & Sigmoid Colon) ▪︎Ulcerations At Splenic Flexure Results Later in Strictures & Large Bowel Obstruction 📍2. Persistent Vomiting 📍3. Passage Of Stool Altered With Blood (Bloody Diarrhea) 📍4. Abdominal Tenderness Then Rigidity 📍5. Hypovolaemic Or Septic Shock 📍6. Symptoms Out Of proportion To The Physical Findings يعني عنده أعراض كل شيء قوي بس لمن نفحص نشوفة زين 🔶B. Chronic Ischaemia 📍1. Severe Central Colicky Abdominal Pain After 30-60 Minutes Of Eating (Mesenteric Angina) With Nausea & Vomiting 📍2. Weight Loss & Diarrhea (Due To Malabsorption & Fear Of Eating) 📍3. Other Features Of Atherosclerosis ➡️ Coronary Artery Disease/Intermittent Limb Claudication/Renal Impairment/Hypertension 🔹Dx Of Bowel Ischaemia 📍1. CBC ➡️ High Leukocytosis (Neutrophils) 📍2. ABG ➡️ Metabolic Acidosis 📍2. Abdominal Xray & Contrast CT ▪︎Thickened Bowel Loops ▪︎No Gas in The Lumen ▪︎Gas in Bowel Wall & Mesenteric & Portal Veins ▪︎Thumb-printing Sign (SubMucosal Edema) On Barium Enema ➡️ Ischemic Colitis ▪︎No Bowel Enhancement On Contrast CT Scan (Confirm Dx) 📍3. Endoscopy ➡️ See Hemorrhagic Edema Of Bowel Lumen 📍4. Mesenteric Angiography ➡️ For Dx Of Chronic Mesenteric Ischaemia 🔹Mx Of Bowel Ischaemia 🔶A. Acute Ischaemia 📍1. Aggressive Resuscitation (Fluids) 📍2. Laparotomy Then (Embolectomy Via ileo-Colic Artery) Or (Vascular Bypass) To Revascularize The SMA 📍3. Resection Of The Dead Bowel Segments ▪︎In Youngs ➡️ Can Do Extensive Resection (Youngs Can Restore The Digestive & Absorptive Function) ▪︎in Elderly ➡️ Do Limited Resection Or Only Conservative Tx ▪︎Small Bowel Transplantation 📍4. Postoperative Anticoagulants 🔶B. Chronic Ischaemia 📍1. Mesenteric Vessels Stenting Or Dilatation (Angioplasty) 📍2. Mesenteric Bypass مثل الكبج مال القلب 📍3. Smoking Cessation 📍4. Anticoagulants

🟢Comparison of scrotal swelling... 📚

Topic of the day is #Small_Bowel_Diverticulae@Clinicalsurgeryround.

🔰Small Bowel Diverticulae 🔶A. Acquired ▪︎Develop in Jejunum ➡️ Due To Mucosal Herniation At The Point Of Entry Of Blood Vessels ▪︎Usually Multiple 🔹 Clinical Features 1. Mostly Asymptomatic & Present As Incidental Finding 2. Malabsorption (Due To Stasis & Bacterial Overgrowth) 3. Acute Diverticulitis (Pain & inflammation) 4. Perforation 5. Bleeding 🔹Mx Of Symptomatic Jejunal Diverticulae 📍1. Limited عددها قليل ➡️ Do Elective Resection Of Affected Bowel Segment 📍2. Extensive عددها هواي ▪︎Give Prolonged Antibiotics (Metronidazole/Ciprofloxacin/Rifaximin) ▪︎Because It's Not Possible To Resect Long Segments Of Small Bowel (Risk Of Short Bowel Syndrome) 📍3. Emergent Diverticulitis (Perforation Or Bleeding) ➡️ Emergent Resection Of The Affected Segment With Anastomosis Or Stoma Formation 🔶B. Congenital (Meckel's Diverticulum) ▪︎it's A Congenital Diverticulum (Contains All The Three Coats Of The Bowel Wall) Emerges From The Persistent Remnant (Failure Closure) Of The Vitello-intestinal Duct ▪︎Most Common Congenital Abnormality Of The GIT ▪︎Arise From The Anti-Mesenteric Side Of The ileum (Small Bowel) ▪︎60cm (2 Feet) From IleoCaecal Valve ▪︎5cm (2inches) in Long ▪︎2cm in Diameter ▪︎Present in 2% Of The Population ▪︎Has its Own Blood Supply ▪︎Contain Ectopic Mucosa ➡️ Gastric (50%)/Colonic/Pancreatic/Endometrial 🔹Clinical Features & Complications 📍1. Mostly Asymptomatic 📍2. Most Presentation At Childhood & Early Adulthood 📍3. GIT Bleeding (Painless Dark Rectal Bleeding Or Melaena) ▪︎Due To Peptic Ulceration Of HetroTropic Gastric Mucousa ▪︎Meckel's is The Most Common Cause Of Severe GIT Bleeding in Children 📍4. Diverticulitis (Abdominal Pain & Tenderness With Pyrexia & Leukocytosis) ▪︎Mistaken As Appendicitis Or Perforated Duodenal Ulcer ▪︎If Normal Appendix Found At Surgery ➡️ Always Suspect Meckel's Diverticulum 📍5. Intussusception ➡️ Meckel's Act As A Leading Point For ileo-ileal Or ileo-Colic Intussusception 📍6. Bowel Obstruction & Volvulus ➡️ Due To Band Between The Apex Of The Diverticulum & The Umbilicus 📍7. Chronic PeriUmbilical Abdominal Pain ➡️ Due To Chronic Mucosal Ulceration 📍8. Meckel's Perforation 🔹Dx ➡️ Gamma Scan Of The Abdomen After IV Injection Of ⁹⁹m Tc-Pertechnetate ➡️ Detect Ectopic Gastric Tissue 🔹Mx Of Meckel's Diverticulum 📍1. Found Incidentally ➡️ Do Nothing If it Has Wide Mouth & Not Thickened 📍2. Symptomatic ▪︎Normal Base ➡️ Do Excision Of The Diverticulum (Meckel's Diverticulectomy) ▪︎Indurated Base ➡️ Do Limited Bowel Resection Of The Involved Segment & Anastomosis

Topic of the day is #Colonic_diverticula@Clinicalsurgeryround

🔴Bowel Diverticulae

▪︎Diverticulae Are Small Bulges (Out-Pouching Or Herniation) Of Some Layers Of Bowel Wall Outside The Bowel Lumen Through Weak Points

🔹Types Of Diverticulae

📍1. Congenital ▪︎All The Three Coats Of The Bowel (Mucous & Submucosa & Muscularis Layer) Present in The Wall Of The Diverticulum ▪︎Like Meckel's Diverticulum 📍2. Acquired ▪︎Only Two Bowel Layers (Mucosa & Submucosa) Present in The Wall Of Diverticulum (No Muscularis Layer) ▪︎Like Colonic & Jejunal Diverticulae

🔰Acquired Colonic Diverticulae

▪︎Mostly Occur in Old Ages (70 Years) ▪︎More in Sigmoid & Descending Colon (Left Colon) ▪︎Occurs Due To High Chronic Pressure Over The Bowel Wall

🔹Risk Factors For Colonic Diverticulae

1. Old Age 2. Low Dietary Fibers 3. Obesity & Low Physical Activity 4. Smoking & Alcohol 5. High Red Meat Consumption 6. Bowel Motility Disorders 7. Chronic Constipation

🔹Clinical Features & Complications

📍1. Mostly Asymptomatic 📍2. Mild Symptoms Resemble Irritable Bowel Syndrome (IBS) ➡️ Constipation & Distension & Flatulence & Heaviness Sensation in Lower Abdomen 📍3. Acute Diverticulitis ▪︎Persistent Pain & Tenderness in Lower Abdomen (Left Iliac Fossa LIF) ▪︎Associated With Change in Bowel Habit (Diarrhea Or Constipation) & Fever & Tachycardia ▪︎Tender & Thickened Sigmoid Colon On Palpation ▪︎Tender Mass On Rectal Examination (Abscess Formation) 📍4. Perforation Then Abscess Formation Or Peritonitis 📍5. Bowel Obstruction ➡️ Due To Fibrosis & Stenosis Or Loops Adherence To Each Other 📍6. Painless Profuse & Recurrent Rectal Bleeding (Due To Vessel Erosion Near The Diverticulum) ▪︎Bright Red With Clots ➡️ Bleeding From Sigmoid ▪︎Dark Color ➡️ Right Colonic Bleeding 📍7. Fistula Formation ▪︎Colo-Vesical (Between Colon & Bladder) ➡️ Most Common & Results in Recurrent UTI/PneumaTuria/Faeces in Urine ▪︎Colo-Vaginal ➡️ More Common After Hysterectomy ▪︎Entero-Colic ▪︎Colo-Cutaneous ➡️ After Percutaneous Radiological Intervention

🔹Dx Of Colonic Diverticulae

1. Abdominal CT & CT Colongraphy (Gold Standard) 2. Double Contrast Barium Enema 3. Colonoscopy

🔹DDX Of Colonic Diverticulae

1. Colo-Rectal Cancer 2. IBS & IBD 3. Gastroenteritis 4. Ischemic Colitis 5. Angiodysplasia (Rectal Bleeding)

🔹Mx Of Colonic Diverticulae

🔶A. Mild Uncomplicated Cases

📍1. High Fiber Diet & High Fluid intake 📍2. Laxatives 📍3. Anti-Spasmodics (Mebeverine/Propantheline) 📍4. Elective Surgical Resection Of The Affected Segment (Sigmoid Colectomy) ➡️ Usually Done Laparoscopically For Recurrent Attacks

🔶B. Acute Diverticulitis

📍1. IV Fluids & Analgesics & Antibiotics (Amoxicillin/Gentamycin/Metronidazole) 📍2. Nill By Mouth 📍3. Urine Catheter (Decrease Risk Of Colo-Vesical Fistula) 📍4. If PeriColic Abscess Developed ➡️ Do Percutaneous Drainage (if Not Resolved With AB & Abscess Diameter >5cm) 📍5. Emergent Open Laparotomy ▪︎Indications ➡️ Perforation & Peritonitis/No Response To Medical Tx ▪︎Operation ➡️ Hartmann's Procedure (Sigmoid Resection With LIF Colostomy & Closure Of Rectal Stump)

🔶C. Bleeding

📍1. Mostly Stops Spontaneously 📍2. If Continuous Bleeding ▪︎Do Angiography Then Colonoscopy (To Locate & Stop The Bleeding) ▪︎If Site Of Bleeding Can't Localized ➡️ Do Open Laparotomy & SubTotal Colectomy & Ileostomy

🔶D. Fistula ➡️ Do Resection Of Affected Segment

Topic of tonight is #Gastric_Cancers@Clinicalsurgeryround

🔹Metastasis Of Gastric Cancer

📍1. Direct Spread ➡️ To Muscularis & Serosal Layers Then To Adjacent Organs (Pancreas/Colon/Liver)

📍2. Lymphatic Spread ➡️ To SupraClavicular LN (Troisiers' Sign)

📍3. Distant Metastasis (Blood) ➡️ Liver/Lung/Bone

📍4. TransPeriToneal Spread

▪︎To The Umbilicus (Sister Mary Joseph's Nodule) ▪︎To The Ovaries (Krukenberg's Tumour)

🔹Mx Of Gastric Cancer

🔶A. Curable Case

📍1. Preoperative Chemotherapy (Neoadjuvant) For Down Staging Of The Tumour 📍2. Total Tumour & Lymph Nodes Resection ▪︎Total Gastrectomy ▪︎SubTotal Gastrectomy (For Distally Located Tumors) 📍3. Postoperative Chemotherapy (Adjuvant)

🔶B. Incurable Case

▪︎Incurable Due To 1. Distant Metastasis 2. Peritoneal Metastasis 3. Stage N4 & Beyond 4. Fixation To Vital Structures Can't Removed

▪︎Options

1. Symptomatic Tx 2. Palliative Chemo-RadioTherapy 3. Stenting For Gastric Outlet Obstruction 4. Pallative Surgery (Gastric Bypass/Mass Resection)

🔹Postoperative Complications Of Gastrectomy

▪︎Early Complications 1. Leakage Of Anastomosis 2. Biliary Peritonitis 3. Secondary Haemorrhage ▪︎Late Complications 1. Dumping Syndrome & Diarehea 2. Nutritional Deficiency (B12 Deficiency)

🔹Prognosis Of Gastric Cancer

1. In Japan 75% 5-Year Survival Rate 2. In West 25-30% 5-Year Survival Rate 3. Most Common Site Of Recurrence ➡️ Gastric Bed