Act as a Surgeon 🧠🔪
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🟡 Duct of Luschka (Subvesical duct) is a small accessory bile duct located near the gallbladder bed.
⚠️ Why is it important?
It may be injured during cholecystectomy, causing a postoperative bile leak.
If injured and not recognized or ligated:
Duct of Luschka injury → Bile leak → Biloma → Abdominal pain / fever / bile in the drain.
🔑 Remember:
Bile leak after cholecystectomy → think of cystic duct stump leak or Duct of Luschka injury.
مهم تفرق بين هذه المصطلحات سواء كنت مستوى أول وحتى سنة الإمتياز :
● [Cholelithiasis ] stone in gallbladder ● [Choledocholithiasis ] stone in common bile duct ● [Cholecystitis ] inflammation of gallbladder ● [Cholangitis ] inflammation of biliary tree 🩺
Repost from N/a
الفيديوهات الذي عرضهم اليوم
الدكتور محمد المسيبلي
لموضوع Valve disease
#surgery
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🐍 𝗖𝗢𝗕𝗥𝗔 𝗛𝗘𝗔𝗗 𝗦𝗜𝗚𝗡
🩻 𝗪𝗵𝗮𝘁 𝗱𝗼𝗲𝘀 𝗶𝘁 𝗺𝗲𝗮𝗻?
The cobra head sign is a classic radiological appearance associated with an adult-type ureterocele. 🐍
🔎 𝗜𝗺𝗮𝗴𝗶𝗻𝗴 𝗙𝗲𝗮𝘁𝘂𝗿𝗲𝘀:
▪️ A bulge of the distal ureter into the urinary bladder
▪️ The protruding ureter is surrounded by a thin radiolucent line
▪️ The appearance is best appreciated when the bladder is filled with contrast material 💉
🐍 The combination of the contrast-filled bladder + distal ureteric bulge + surrounding thin lucent rim creates the characteristic “cobra head” appearance.
🧠 𝗞𝗲𝘆 𝗣𝗼𝗶𝗻𝘁:
👉 Cobra Head Sign = Ureterocele, particularly the adult-type ureterocele.
📌 Recognizing this classic sign can help identify a ureterocele on contrast imaging even when the clinical presentation is subtle.
🔬 𝗥𝗮𝗱𝗶𝗼𝗹𝗼𝗴𝘆 𝗶𝘀 𝗮𝗯𝗼𝘂𝘁 𝗿𝗲𝗰𝗼𝗴𝗻𝗶𝘇𝗶𝗻𝗴 𝘁𝗵𝗲 𝗰𝗹𝗮𝘀𝘀𝗶𝗰 𝗽𝗮𝘁𝘁𝗲𝗿𝗻. 🧠
Medical Triad’s and it’s Dignosis
Fever
Jaundice
Right upper quadrant (RUQ) pain
[Charcot’s Triad ]
✅[ Acute cholangitis]
Endothelial injury
venous stasis hypercoagulability
[Virchow’s Triad]
✅ [Venous thrombosis]
Hypoglycaemia
Low plasma glucose
Resolution with glucose intake
✅ [Insulinoma]
Hypotension
Muffled heart sounds
Elevated jugular venous pressure (JVP)
✅ [Cardiac tamponade]
🔹 𝗦𝗧𝗘𝗣-𝗟𝗔𝗗𝗗𝗘𝗥 𝗦𝗜𝗚𝗡 🪜
🩻 𝗪𝗵𝗮𝘁 𝗱𝗼𝗲𝘀 𝗶𝘁 𝗿𝗲𝗽𝗿𝗲𝘀𝗲𝗻𝘁?
The step-ladder sign is a classic radiographic pattern associated with small bowel obstruction (SBO), particularly mechanical obstruction.
🪜 𝗥𝗮𝗱𝗶𝗼𝗴𝗿𝗮𝗽𝗵𝗶𝗰 𝗮𝗽𝗽𝗲𝗮𝗿𝗮𝗻𝗰𝗲:
🔸 Multiple dilated small-bowel loops become filled with gas and fluid.
🔸 These loops are arranged in a parallel, stacked configuration, producing the characteristic step-like appearance.
🔸 The pattern is especially conspicuous when the loops contain multiple air–fluid levels.
💧 𝗔𝗶𝗿–𝗙𝗹𝘂𝗶𝗱 𝗟𝗲𝘃𝗲𝗹𝘀:
On an erect or lateral decubitus abdominal X-ray, gas rises above the fluid within the dilated loops. This produces several horizontal air–fluid interfaces at different heights, resembling the steps of a ladder.
⚙️ 𝗣𝗮𝘁𝗵𝗼𝗽𝗵𝘆𝘀𝗶𝗼𝗹𝗼𝗴𝘆:
When a mechanical blockage occurs, intestinal contents and gas accumulate proximal to the obstruction. Increasing intraluminal pressure causes bowel dilatation, while the mesenteric attachments influence the orientation of the dilated loops, giving them their characteristic stacked appearance.
📍 The dilated loops may show a distribution extending from the right lower abdomen toward the left upper abdomen.
🚨 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗦𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮𝗻𝗰𝗲:
Recognizing the step-ladder pattern can support the diagnosis of acute intestinal obstruction. Prompt recognition is important because significant obstruction can progress to complications such as bowel ischemia, strangulation, or perforation, potentially requiring urgent intervention.
🧠 𝗞𝗲𝘆 𝗣𝗼𝗶𝗻𝘁:
Multiple dilated small-bowel loops + stacked air–fluid levels at different heights → think of the STEP-LADDER SIGN 🪜🩻
Acute Appendicitis on CT: The key signs are an enlarged appendix, wall thickening/enhancement, periappendiceal fat stranding and appendicolith. CT also helps detect perforation and abscess.
