Medspace universal

الكتاب الصادر من لجنة عمداء كلية طب العراق بخصوص تحديد المصادر المتفق عليها لقراءة المواد للامتحان الوزاري وكالاتي : Surgery = bailey & love Medicine = Davidson's Gynecological & Obstetrics = ten teacher Pediatric = nelson

كورس الكسور للدكتورة فرح 💜

السلام عليكم كورس الكسور صار متوفر للجميع للاستفاده منه خصوصا طلاب مرحله ٥ طب بغداد لان الشرح عله المحاضرات https://youtube.com/playlist?list=PLXB_65eVFL7INQXeaYreimwmb8b6Ak-_G&si=iAY-6M80aa3fSYAs

السلام عليكم طلاب بمناسبة تعيين دكاترتنا قررنا نسوي تخفيض على كورس Davidson Mcq الشامل لكارديو بواقع ٨ محاضرات رسبايرتوي ٨ محاضرات نفرولوجي / رينال ٥ اندوكراين ٤ هضمية ٦ السعر صار ٥٠ بدل ٧٥🎉🎉🎉لاول ١٠ طلاب بمناسبة اشتراكنا بالاب الجديد coursati للتفاصيل @DrMOH98

اكثر شرح وافي ومفهوم ومختصر لمرض السكري 🗒👆👆

Diabetes | Diabetes Treatment (B&B 2022)

Diabetes | Insulin (B&B 2022)

Diabetes | Diabetes Complications (B&B 2022)

Diabetes | Diabetes Mellitus (B&B 2022)

#كسور foot drop من المواضيع المهمة بالكسور وتتكرر بmcq🎉🎉📢 Foot drop, sometimes called drop foot, is a general term for difficulty lifting the front part of the foot. Causes Foot drop is caused by weakness or paralysis of the muscles involved in lifting the front part of the foot. Causes of foot drop might include: 1. Nerve injury. The most common cause of foot drop is compression of a nerve in your leg that controls the muscles involved in lifting the foot (peroneal nerve). This nerve can also be injured during hip or knee replacement surgery, which may cause foot drop. 2. A nerve root injury — "pinched nerve" — in the spine can also cause foot drop. People who have diabetes are more susceptible to nerve disorders, which are associated with foot drop. 3. Muscle or nerve disorders. Various forms of muscular dystrophy, an inherited disease that causes progressive muscle weakness, can contribute to foot drop. So can other disorders, such as polio or Charcot-Marie-Tooth disease. 4. Brain and spinal cord disorders. Disorders that affect the spinal cord or brain — such as amyotrophic lateral sclerosis (ALS), multiple sclerosis or stroke — may cause foot drop.

Types of hemorrhage (important definitions) ◼️Primary hemorrhage : It is defined as bleeding which occur at the same time as the injury or operation. ◼️Reactionary hemorrhage : It is bleeding which follow primary hemorrhage within 24 hours and usually within 4 to 6 hours, it is mainly due to slippage of a vascular ligature, for example a surgeon places a ligature flush with the cut end of the mesoappendix is easily liable to slip and bleed postoperatively, or it may be due to dislodgement of a clot or cessation of reflex vasospasm, precipitating factors can include a rise in blood pressure, coughing and vomitting which may increase the venous pressure leading to a reactionary venous hemorrhage which can be very difficult to control even by an experienced surgeon. ◼️Secondary hemorrhage : Defined as hemorrhage occuring after 7-14 days and it is due to infection and sloughing of a part of a vessel wall, in this case there is usually small warning hemorrhages appearing as bright red stains on the dressing, followed by a large potentially fatal hemorrhage, it may also result from pressure necrosis such as from a drain, or from malignancy eroding a vessel

من اهم مواضيع اوسكي الجراحة Classes of hemorrhage: ◼️ Hemorrhage from any source can be classified based on volume of blood lost into four classes. ◼️Class I hemorrhage involve loss of up to 15% of whole blood volume, this is about 750 mL of blood in an average adult, there is little in terms of clinical effects on cardiorespiratory function at this stage, blood pressure remains normal, heart rate is usually normal or minimally raised, pulse pressure, respiratory rate and mental status usually remain normal. ◼️In class II hemorrhage there is loss of 15% to 30% of blood volume, this amount to around 750 mL to 1500 mL of total blood volume, there is usually a tachycardia of 100-120 beat per minute, respiratory rate becomes 20-24 cycles per minute, blood pressure usually remains normal in the supine position but such patients may show postural hypotension (reduction of SBP of atleast 20 mmHg or a reduction in DBP of atleast 10 mmHg within 3 mins of erect posture), additionally the patient may look anxious. ◼️In Class III hemorrhage there is loss of 30% to 40% of total blood volume, this is about 1500 mL to 2000 mL, there is significant tachycardia of more than 120 beat per minute, significant hypotension, tachypnea and confusion, therefore the full blown picture of hemorrhagic shock usually develops at class III hemorrhage (loss of atleast 1500 mL of blood). ◼️Class IV hemorrhage is loss of more than 40% of blood volume, about over 2 litres, this is immediately life threatening and generally justifies extremely urgent operative control of the bleeding source, tachycardia is usually greater than 140 bpm (some patients may develop paradoxical bradycardia in rapid massive bleeding) tachypnea, severe hypotension and obtundation. ◼️It must be noted that young fit patients may maintain a near normal blood pressure until the very end, such patients usually develop precipitous cardiovascular collapse after maintaining a relatively high blood pressure for longer time, on the other hand, old frail patients usually develop severe hypotension with relatively lower amount of blood loss, more over they could be taking drugs that promote bleeding (e.g warfarin, aspirin) or mask features of hemorrhagic shock (e.g beta blockers). ◼️Analysis of clinical data has shown that a systolic blood pressure of less than 110 mmHg should be regarded as a definition of hypotension in the trauma and bleeding patients, because it was found that mortality significantly increase when SBP drops below this point. ◼️Note that urine output progressively decrease as the patient advances from one class to another, there is a marked oliguria in class III (less than 1mL/kg/Hr in infants, less than 0.5 mL/kg/Hr in children and less than 400 mL per 24 hours in adults) and nearly anuric in class IV. #Shock #جراحة

Grid iron incision for Appendectomy Grid-Iron, is a criss-cross pattern of metal bars, like in a grill, a Gridiron incision was first described by McBurney in 1894, McBurney gave this name to resemble the criss-cross pattern of external oblique fibres and the underlying internal oblique and transversus abdominis muscles, as they are splitted during appendicectomy, the window created resembles a Gridiron. Above figure shows Dr. McBurney operating on a patient in 1901.

من للمواضيع المهمة جدا في الطوارئ والجراحة وتكرر كثيرا في الاوسكيات 📢📢🚫 Management plan for acute upper GI bleeding ◼️The following plan is contemplated for non variceal bleeding, this is because variceal bleeding has its own implications. ◼️The first and most important step is to gain intravenous access by a wide pore IV cannula. ◼️Following this, resuscitation is started by crystalloid IVF to raise the blood pressure and blood transfusion and oxygen therapy may be required in shocked patient with active bleeding, a central venous line may be done to monitor volume of replacement needed, this is especially important in patients with cardiac disease. ◼️Perform an initial clinical assessment, check for the circulatory status by measuring the pulse rate, blood pressure and urine output, also check for signs of chronic liver disease such as splenomegaly, caput medusae and spider nevi as bleeding can be variceal in origin, check for clinical signs of comorbidity, such as cerebrovascular, renal or cardiorespiratory disease, both because these are worsened by active bleeding and makes endoscopic or surgical intervention more dangerous. ◼️After being done from the initial assessment, perform basic investigations which includes the following: 1) Complete blood count = Anemia indicate that bleeding is chronic or subacute, in acute massive bleeding hemoglobin concentration is initially normal, until hemodilution occurs, Thrombocytopenia is a clue to hypersplenism, a feature of chronic portal hypertension secondary to chronic liver disease. 2) Blood urea and creatinine = Blood inside the lumen is broken down, the products of which are absorbed and converted in the liver to urea, therefore, elevation of urea in presence of normal creatinine indicates massive acute bleeding, if creatinine is also elevated, suspect renal failure. 3) Liver function tests = Elevated liver enzymes points towards chronic liver disease and gives a clue that variceal bleeding is likely. 4) Prothrombin time = preferrable if the patient has evidence of liver disease or is on anticoagulation therapy. ◼️After clinical and basic laboratory assessment, you should be able to calculate Blatchford score, a score of 2 or less indicate a very good outcome, a progressively higher score indicate progressively worse outcomes. ◼️The next step is to perform an endoscopy to diagnose the cause of bleeding, this is possible in 80% of cases, endoscopy is performed after full resuscitation and within 24 hours, the source of bleeding can be delt with by mechanical methods such as clips, or thermal methods such as heater probe, either of these methods should be combined with adrenaline injections, this is called Dual therapy and it significantly reduce risk of rebleeding. ◼️Surgical intervention is indicated in the following scenarios : 1) Active bleeding could not be controlled by endoscopy. 2) Rebleeding had occured one time in the elderly frail patient. 3) Rebleeding had occured two times in the younger fitter patient. #جراحة

السلام عليكم طلاب باجر ان شاء الله ينطلق كورس الباطنية الشامل حيغطي 70% من امتحان باطنية طب بغداد هذا الكورس مصمم لطلاب المرحلة الرابعة والسادسة وطلاب المعادلة والموازي في طب بغداد 🌹🌹 حيكون متضمن شرح محاضرات الباطنية لطب بغداد للمواد الخمسة الاساسية بواقع محاضرتين باليوم قلبية تتفسية هضمية رينال اندوكراين للاشتراك بهذا الكورس السعر ١٠٠ الف وكورس شرح مصدر Davidson Mcq الي اغلبالاسئلة تجي منه وسعره ٧٥ الف الرفع حيكون عالتطبيق الي دزيته الكم اشتركوا بي ودفعوا المبلغ وبلشوا دراسة ويانا🌹🌹 🎉🎉🎉السعر حاليا ٧٥ الف الكورسين 🎉🎉🎉 بدل ١٧٥ وهذا لاول ٢٠ مشترك فقط وراها يرجع للسعر الاصلي ١٧٥ https://t.me/+VIxFXarux0NjMjdi

Carcinoid syndrome and the carcinoid crisis ◼️Carcinoid syndrome is considered a paraneoplastic syndrome caused by release of biologically active peptides from neuroendocrine tumors. ◼️Not all neuroendocrine tumors are functioning, only those who produces active substances have the potential to produce the carcinoid syndrome. ◼️Carcinoid tumors can arise from diverse sites such as lungs, ovaries, prostate and bile ducts, but the commonest are gastrointestinal carcinoids, out of these the appendix is the most common site followed by the ileum, duodenum and jejunum. ◼️If carcinoid syndrome develops in those with a gastrointestinal tumor, the likelihood of hepatic metastasis is high as tumor products are able to enter the systemic circulation without being metabolized by the liver first, on the other hand development of carcinoid syndrome may point to retroperitoneal invasion which again for the same reason produces carcinoid syndrome. ◼️Functional carcinoid tumors may produce over 40 different products, the contribution of each product to the syndrome is not clear, the main products include serotonin, histamine, Tachykinins, kallikrein and prostaglandin, tryptophan metabolism is hugely altered in carcinoid syndrome, there is a shift in the conversion of tryptophan to serotonin from 1% in the normal state to up to 70% in those with the disease, this can cause increased tryptophan consumption and lead to the development of Pellagra. ◼️Flushing is the most common feature, it affects about 85% of patients, it is mainly observed in the face and upper thorax. ◼️Diarrhea is the second most common feature, it has been linked mainly to serotonin which increases gut motility. ◼️Bronchospasm leading to wheeze and shortness of breath is a less common feature affecting about 15% of patients. ◼️Carcinoid heart disease is strikingly very common, it affects two thirds of all patients, it is attributed mainly to the effect of serotonin on cardiac fibroblasts, activation of 5HT2b receptors is known to stimulate fibroblast mitogenesis, pathologically the disease is seen as fibrotic endocardial thickening affecting mainly the right heart, this usually leads to tricuspid and pulmonic valve retraction and regurgitation, stenotic lesions can also occur, left heart lesions are uncommon except in those with patent foramen ovale, this is obviously because serotonin is metabolised by pulmonary endothelial cells, such effects on the heart can cause heart failure and they do not regress with somatostatin analogues, however these drugs may mitigate disease progression. ◼️Other features may include fatigue, muscle loss, and cognitive impairment, late complications can include retroperitoneal and mesenteric fibrosis. ◼️Carcinoid crisis is an acute extreme exacerbation of carcinoid syndrome, this results from release of large amounts of tumor products, this may occur during surgery due to tumour manipulation, or during induction of anesthesia or epinephrine administration, carcinoid crisis is an emergency and it may lead to severe hypotension or hypertension, dangerous cardiac arrhythmias, marked bronchospasm, and hyperthermia. ◼️Intraoperative administration of somatostatin analogues can mitigate risk of carcinoid crisis, it should be noted that carcinoid crisis may arise simply due to clinical examination of a palpable tumor, or even sometimes due to spontaneous necrosis of the tumor or induced necrosis due to therapeutic embolisation, so any "tumor stress" may trigger the crisis. #جراحة #oncology