كل يوم case 🫀🩻🩺

A 51-year-old woman presents to the emergency department with a painful right groin. She also has some lower abdominal distension and has vomited twice on the way to the hospital. She has passed some flatus but has not opened her bowels since yesterday. She is otherwise fit and well and is a non-smoker. She lives with her husband and four children. On examination she looks unwell. Her blood pressure is 106/70 mmHg and the pulse rate is 108/min. She is febrile with a temperature of 38.0°C. The abdomen is tender, particu- larly in the right iliac fossa, and there is lower abdominal distension. There is a small swelling in the right groin which is originating below and lateral to the pubic tubercle. The lump is irreducible and no cough impulse is present. Digital rectal examination is unremarkable and bowel sounds are hyperactive.

colonic ischemia refers to ischemia that affects the colon, mesenteric ischemia refers to ischemia that affects the blood vessels of the small intestine Both had abdominal pain with bloody diarrhea in severe ischemia Investigations like CT abdomen can diffentiate between them جواب دكتور قصي زوين

ischemic colitis vs Mesenteric Ischemia شنو الفرق ؟

Questions • What is the likely diagnosis? • What are the classical characteristics to indicate this? • What are the most common causes? • Which are the most common organisms? • How should the patient be managed? • What investigations should be performed?

اجاني بالاوسكي تقريبا مثله بس الفرق بعد العمليه طلعت هاي الاعراض As the junior doctor on call, you are asked to review the blood results of an 87-year-old man who was admitted that morning with possible appendicitis. He is confused and unable to give an accurate history. He had been spiking temperatures during the afternoon and had increasing right-sided abdominal pain. examination The observation chart shows he has a temperature of 38°C and a tachycardia of 120/min. You notice he has a yellow discolouration of the skin and sclera, and abdominal examination reveals that the maximal tenderness is in the right upper quadrant. There are no palpable masses or abdominal herniae. Rectal examination demonstrates normal stool with no palpable rectal mass. A plain abdominal radiograph, done that morning, was normal.

• Whose sign is elicited on examination of the abdomen? • What is the most likely diagnosis? • What is your first-line treatment? • What would you prescribe to treat the high blood glucose? • What specific complication is this patient at risk of?

A 44-year-old woman presented to the emergency department with a 1-day history of constant abdominal pain and vomiting. The pain came on suddenly, shortly after eating her evening meal. This was followed by intermittent bouts of bilious vomiting. She has diabetes and is concerned about her blood sugars as she has not been able to eat a normal diet since the pain started. Her bowels have opened normally and she has no urinary symptoms. #surg1

A 66-year-old woman is seen in the outpatient clinic for an evaluation of weight loss. The patient says that 6 months ago her weight was 155 lb (70.5 kg) but over the past several months has steadily declined to 105 lb (47.7 kg). The patient attributes her weight loss to an inability to eat. She indicates that whenever she tries to eat a meal, she develops intense abdominal pain that is severe and diffuse throughout the entire abdomen. To avoid this pain, the patient has limited herself to small meals and soups. She denies any fever, malaise, nausea, vomiting, or constipation. Her past medical history is significant for hypertension for which she takes an angiotensin-converting enzyme inhibitor. She smokes approximately one pack of cigarettes per day and consumes two glasses of wine per day. The physical examination reveals a thin woman in no distress. Her skin and sclera are nonic- teric, and bilateral carotid bruits are present. The results of her cardiopulmonary examination are unremarkable. The abdomen is scaphoid, nontender, and without masses. Her stool is Hemoccult negative. Her femoral pulses are diminished, with audible bruits bilaterally. The pulses are diminished in both lower extremities. Laboratory evaluations are obtained revealing a normal complete blood count and normal electrolyte levels. The serum urea nitrogen, creatine, and glucose values are within the normal range, as are the results from a urinalysis. The 12-lead elec- trocardiogram reveals a normal sinus rhythm. What is the most likely diagnosis? What is the most likely mechanism causing the problem? What is the best treatment? هذا الكيس اقرو حتى تعرفون شلون يجي برزنتيشن ابو Mesenteric Ischemia

A 22-year-old woman is brought to the emergency department by ambulance. Her friend says that they had been out drinking and that she had fallen off a 4-foot wall landing directly on her left knee. Her knee swelled up immediately and she has not attempted to walk since the injury. She is normally fit and healthy. She takes the combined oral con- traceptive pill, smokes 10–20 cigarettes a day and works in a supermarket. • What injury has this woman sustained? • How should it be managed? #surg2

A 25-year-old man was playing football for his local team. While going in for a tackle he sustained a twisting injury to his knee. There was no immediate swelling. He continued to play for about ten minutes to the end of the game but then complained of some pain in the medial aspect of his knee. He awoke the next day with a painful swelling in the knee and so consults his general practitioner. Examination This young man has some mild swelling, associated with marked tenderness to palpation over the medial joint line. He has normal varus/valgus stability of the knee and a negative anterior draw and Lachman’s test. The range of motion is full. A plain X-ray shows good preservation of the joint space, • What is the diagnosis? • What are the common clinical features of this injury? • How would you manage this injury?

1 A 22-year-old figure-skater presents with a painful locked knee with limited extension following a twisting injury. 2 A 24-year-old footballer presents with a painful knee after landing awkwardly and twisting his knee after a header. With the quadriceps relaxed, there is exces- sive anterior glide of the tibia on the femur. 3 A 14-year-old girl successfully treated for rickets 3 years ago shows bow-legged deformity. 4 A 16-year-old boy complains of a painful knee during exercise and a tender lump over the tibial tuberosity. 5 A 50-year-old carpet layer presents with a swelling directly over the patella. The joint feels stable and there is no effusion.

Q13: A patient is admitted to the hospital with a nursing-home–acquired pneumonia. His blood pressure is normal and the extremities well-perfused. Admission creatinine is 1.2 mg/dL. UA is clear. The patient is treated on the floor with piperacillin/tazobactam and improves clinically. On the fourth hospital day, the patient notes a nonpruritic rash over the abdomen. The creatinine has risen to 2.2 mg/dL. The urinalysis shows 2+ protein, 10 to 15 WBC/hpf, and no casts or RBCs. Q14: A 62-year-old man is admitted with pneumonia and severe sepsis. Vasopressors are required to maintain peripheral perfusion, and mechanical ventilation is needed because of ARDS. Admission creatinine is 1.0 mg/dL but rises by the second hospital day to 2.2 mg/dL. Urine output is 300 cc/24 h. UA shows renal tubular epithelial cells and some muddy brown casts. The fractional excretion of sodium is 3.45. Q15: A 76-year-old man is admitted with pneumonia. He has a history of diabetes mellitus. Admission creatinine is 1.2 mg/dL. He responds to ceftriaxone and azithromycin. He develops occasional urinary incontinence treated with anticholinergics, but his overall status improves and he is ready for discharge by the fifth hospital day. On that morning, however, he develops urinary hesitancy and slight suprapubic tenderness. The creatinine is found to be 3.0 mg/dL; UA is clear with no RBCs, WBCs, or protein. Matching A. Prerenal azotemia because of intravascular volume depletion B. Ischemia-induced acute tubular necrosis C. Nephrotoxin-induced acute tubular necrosis D. Acute interstitial nephritis E. Postrenal azotemia because of obstructive uropathy F. Postinfectious glomerulonephritis

A middle-aged woman presents with breathlessness for the last week. She also comments that she has been feeling more tired than usual and that she has been passing urine infrequently. On examination you note that her skin is pale and pigmented with several small bruises. What is the most appropriate initial investigation? a. Urea and electrolytes b. Urine Stix testing and microscopy c. Serum calcium, phosphate and uric acid d. Full blood count e. Renal ultrasound

A 70-year-old man complains of waking up in the night to pass urine, nonspecific bone pain and weight loss. He mentions that there is often a delay in initiating urination and a sense of incomplete voiding. What is the most appropriate initial investigation after a digital rectal examination? a. Urea and electrolytes b. Serum prostate-specific antigen (PSA) c. Renal ultrasound d. Transrectal ultrasound e. Excretion urography

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