Surgery( notes)

Advices before Operations 1 Sliding scale and IV fluids👉 insulin in case of major surgery. 2 Should be continued perioperatively and be changed to IV forms if starvation is prolonged👉 Anticonvulsants 3 This is stopped 3–4 days prior to surgery and restarted on the evening after the surgery👉warfarin for AF. 4 The medications can be given up to the time of surgery and then selectively as required in the immediate postoperative period. The previous dose will need to be recommenced once the patient recovers from surgery.👉 antihypertensive drugs 5 This should be given for at least 2 weeks preoperatively to have any real benefit.👉preoperative nutritional support. 6 This should be stopped at least a month prior to elective surgery.👉smoking 7 The dose on the morning of surgery should be omitted and medications recommenced once the patient has started eating.👉diapetic medication with minor surgery. 8 Patients who have been receiving this on a regular basis (and have received this within the past 2 months) will require increased doses to avoid a crisis.👉steroid #preoperative_notes

warm leg; all peripheral pulses are palpable the best management is 👉Thromboembolic deterrent (TED) stockings and prophylactic Fragmin. A 42-year-old woman presents with primary varicose veins and severe symptoms with a needle phobia. Duplex scan shows an isolated saphenofemoral junction incompetence and long saphenous vein reflux the best management is 👉Saphenofemoral ligation, stripping and stab avulsions. A 48-year-old man has a body mass index (BMI) of 37 and is a heavy smoker. He has primary symptomatic varicose veins with skin changes and duplex scan demonstrates an isolated saphenopopliteal junction incompetence and short saphenous reflux. the best management is 👉Endovascular laser treatment (EVLT). A 40-year-old man has a BMI of 30 and a previous idiopathic iliofemoral DVT. Duplex scan shows complete external iliac vein occlusion. He has significant venous claudication and leg swelling which interferes with his working life the best management is 👉 palma procedure. Scenarios with investigation 1 This is best for distinguishing between venous and lymphatic causes of a swollen limb the best investigation 👉MRI. This is best for diagnosing malignancy in lymph nodes.👉Biopsy of nodes This is best to exclude a pelvic or intra-abdominal mass causing leg swelling👉CT. This provides the best reflection of lymphatic function👉Lymphoscintigraphy. This is no longer used as a first-line test for lymphoedema👉Lymphangiography This can provide useful information on venous abnormalities 👉 US. #vascular

Important short scenarios in Blood Vessels. Scenarios with diagnosis A 70-year-old man has had severe pain at night in his right leg for the past 5 weeks and is unable to sleep. He relieves the pain by sleeping in a sitting position and presents with leg swelling the cause is 👉Critical ischemia. A 45-year-old woman with a pansystolic murmur and bilateral painless limb leg swelling presents to her GP with breathlessness the cause is 👉Congesitve cardicac faliure. A 25-year-old fit male presents with pain and swelling of the leg following a football match the cause is 👉Calf muscle tear. A 60-year-old man has marked leg swelling 1 day after undergoing a femoral distal bypass for critical ischaemia. Pulses are present but the calf is tense and tender the cause is 👉Compartment syndrome. A 30-year-old woman presents with a 1-year history of progressive painless swelling in her left leg. There is no history of DVT or injury.👉Lymphoedema. A 50-year-old man presents with a history of an ingrown toenail which has been exquisitely tender over the past 48 h. The lower leg is hot and swollen the cause is 👉Cellulitis. An 80-year-old woman presents with a painful swollen right leg 6 days after admission for a left hemispheric stroke which has left her bed-bound the cause is 👉DVT A 22-year-old male involved in a motorcycle accident presents to A&E with a fractured femur and, following fixation, is noted to have become disorientated with several areas of petechial haemorrhage the cause is 👉 fat embolism A 75-year-old female presents with a sudden episode of acute pain in the right leg. On examination she has an irregular tachycardia of 120 beats/min and a white, paraesthetic right lower leg. She has no palpable pulses below the groin but her left leg pulses are present and normal the cause is 👉popliteal artery embolism. A 59-year-old male presents to A&E with paralysis and paraesthesia of his lower limbs. On examination there are no femoral pulses and he has mottling of the skin of the lower abdomen the cause is 👉Acute aortic thrombosis. A 65-year-old woman presents to her GP with several recent episodes of temporary left eye blindness which resolved on each occasion after about 5 min. Retinoscopy shows several areas of poor filling in the retinal arteries the cause is 👉cholesterol embolism A 40-year-old IV drug abuser presents with fevers, breathlessness and pain in his right buttock. His temperature is 38ºC and examination reveals marked mottling over the right gluteal area and thigh. He has a grade V aortic murmur the cause is 👉Mycotic embolism. A 55-year-old woman presents with brown discoloration and induration around the ankle and a 3-cm-diameter ulcer lying just above the medial malleolus the ulcer is 👉 Venous ulcer. A 60-year-old man presents with a history of pins and needles in his left foot following multiple back operations and an ulcer over the plantar aspect of his second metatarsal head the ulcer is 👉 neuropathic ulcer A 70-year-old lifelong male smoker presents with a painful ulcer over the head of his first metatarsal where he is noted to have a mild hallux valgus the ulcer is 👉 ischemic ulcer due to arterial disease A 65-year-old man presents with a chronic ulcer of seven years lying over the medial aspect of his calf and which has recently become painful and enlarged the ulcer is 👉Marjolin ulcer. A patient presents with small punched-out, painful ulcers over the dorsum of her foot the ulcer is 👉 ulcer of vasculitis as SLE Scenarios with managements A 75-year-old man presents with a history of DVT 5 years ago and a recently healed venous ulcer. Duplex scan demonstrates isolated popliteal venous reflux the best management is 👉Class 2 support stockings. An 80-year-old woman presents with a recently fractured neck of femur and a swollen painless

Garden classification of femoral neck fractures. Common in elderly #Orthopedic

Very important information Extradural haematomas👉 often present with a lucid interval following the injury when the patient can appear very well. Subdural haematomas👉 are serious injuries often the patient is usually unconscious from the time of injury #trauma.

Intussuseption #GIT

بسم الله الرحمن الرحيم بحزن وألم بالغين وبقلوب مؤمنة بقضاء الله تلقينا نبأ فاجعة لها وقعها المؤلم والمؤسف علينا بالإعتداء بالقتل على زميلنا في جامعة ذمار طبيب الإمتياز /جمعان عبد الكريم السامعي بحرم مستشفى الوحدة التعليمي الجامعي بمعبر فجر يوم  الأحد الموافق 24\9\2023 الموافق 9\3\1445. نحن طلاب دفعة 36 طب بشري جامعة صنعاء نعزي أهل وأسرة الفقيد وكافة محبيه وكافة زملائه في الكلية ونسأل من الله أن يتغمده بواسع الرحمة والمغفرة. وإننا أيضاً بهذه الفاجعة المؤسفة جداً ندين بأشد العبارات هذه الجريمة البشعة ونأكد مطالبتنا للجهات الأمنيه والقضائية سرعة اتخاذ الإجراءات العادلة وتقديم مرتكب الجريمة للعدالة لينال جزائه الرادع...

Causes of unhealed fistula? 🟠His Friends 🟠 1. H_high output fistula 2. S_steroid use 3. F_foreign body 4. R_radiation 5. I_IBD 6. E_epithelialization 7. N_neoplastic 8. D_distal obstruction 9. S_site( gastric, duodenal) #general_notes

Emphysematous pylonephrosis is more common than emphysematous cystitis. DD of neumaturia (presence of air with urine): 1/Gas_forming bacteria as e coli and pseudomonas 2/Intestinourinary fistula. 3/ Iatrogenic by uroscopy د خالد الكحلاني الله يحفظه🌹. #Renal

لماذا يجب التفريق بين الhernia هل هي direct or indirect ???? For priority بمعنى لو معاك حالتين في العياده واحده direct  وواحده indirect ابدا بال indirect لان حقه ال neck is in a narrow internal ring وايضا كلما كان المريض أصغر سنا كلما كان أخطر لان الring عتكون   أضيق د.وليد غيلان

And

🔺The "IV" treatment of H.Pylori is combination of Pantoparzol Metronidazole Levofluxacin د.لؤي القباطي

أيُّها الناس: مَوعِدُكُم معي ليس الدُنيا، مَوعِدُكُم معي عند الحَوض، والله لكأني أنظُر إليه من مقامي هذا أيُّها الناس: والله ما الفقر أخشى عليكم ولكن أخشى عليكم الدُنيا..أن تنافسوها كما تنافسها الذين من قبلكم فتُهلِكُكُم كما أهلَكَتْهُم أيُّها الناس: الصلاة الصلاة، الصلاة الصلاة، الله الله في الصلاة.. أيُّها الناس: اتقوا الله في النساء، اتقوا الله في النساء، أوصيكُم بالنساء خيراً.. أيُّها الناس: إنَّ عبداً خيَّره الله بين الدنيا وبين ما عِند الله، فاختار ما عِند الله.. آواكُم الله، حفظكُم الله، نصركُم الله، ثبَّتكُم الله، أيَّدكُم الله.. أيُّها الناس، أقرِئوا مني السلام كلَّ مَن تبعني من اُمَّتي إلى يوم القيامة. - آخر كلمات سَيِّدنا مُحَمَّد ﷺ 🥺♥️♥️

Femoral ring is half an inch below and lateral to pubic tubercle While the saphenous opening is 4 cm below and lateral to pubic tubercle

Flail chest

🔷TNS staging and Manchester staging of breast cancer 🔷 د.جميلة السنباني

🔷Following trauma, the liver may be ruptured causing profuse bleeding due to its vascularity. In order to control bleeding surgeon use Pringle·s maneuver (in which the hepatic artery is compressed in the free margin of lesser omentum).🔷

🔷Ddx of sterile pyuria = present of pus cells in urine without bacteria?? 🔺TB 🔺Stone 🔺Tumor 🔺Trichomonas vaginalis