Act as a Surgeon 🧠🔪

📍Cholangitis: Infection of the bile duct with Charcot’s triad: fever+rigors , jaundice, RUQ pain. Rx/ Augmentin 1.2g/8h IV. Abdo US & Surgical consultation for urgent ERCP -------------- 📍Choledocholithiasis: 4F (female, forty, fatty, fertile)  It's a Gallstone in common bile duct, causing obstructive jaundice. Rx/Maintain hydration(iv fluid) Rx/prophylactic antibiotics (eg Augmentin 1.2g/8h IV) Exclude pancreatitis and cholangitis, Surgical consultation for ERCP and cholecystectomy https://t.me/Clinicalsurgeryround

Acute pancreatitis:acute abdomen: Constant severe Abd. Pain ⬇️by leaning forward , Epigastric Abd distention, tenderness, N/V. اسأل عن حصوات المرارة هل عمل ERCP؟ ــــــــــــــــــــــــــــــــ Rx/ O2 therapy SOS Rx/ NS infusion 500mg  + dextrose 5% infusion BD(DNS) Rx/ Urine catheter Rx/ NPO + NGT Rx/ fentanyl لايعمل هبوط ضغط( Fentanyl 1mg/kg) Rx/ fentanyl 50mcg iv bolus SOS. Rx/ pantoprazol 40mg iv OD Rx/ plasil or emeset if N/V TDS Rx/ send for CBC(leukocytosis), CRP, s. Amylase & lipase, LFT RFT,( s. Ca+, Na+, K+) Abd. US, abd. CTغالباتُطلب. 🔵 / Consider prophylactic antibiotics if severe (Ceftriaxone 1g iv AST bd + Flagyl infusion tds) ــــــــــــــــــــــــــــــــ ICU Admission if severe: Rx/clexane 60mg SC BD  !?? Rx/send for daily CBC,CRP, RFT, LFT, s. Ca+Na+K+, https://t.me/Clinicalsurgeryround

Acute cholecystitis: acute abdomen: Rx/Klamoks 1.2g iv TDS Or Ceftriaxone 2g iv OD AST. Rx/ Flagyl 500mg iv vial TDS Rx/ Analgesics & antiemetics(Tramadol + plasil حاول تتجنبه لانه يعمل spasm في ال Sphincter of oddi of gallbladder ) or fentanyl 50mcg, or pethedine 25mg iv bolus SOS Rx/ NPO Rx/ NS infusion 500mg BD + dextrose 5% infusion BD Rx/ pantoprazol 40mg iv Rx/ CBC(leukocytosis) , CRP, LFT, Abd. US(if negative >> erect abd x ray) . Rx/ correct electrolytes abnormalities. Rx/ surgical consultation https://t.me/Clinicalsurgeryround

📎 MEN 1 Syndrome || Multiple Endocrine Neoplasia Type 1 ➡️Previously called Wermer's Syndrome🔥.

📎Definition:

➡️A rare inherited (Autosomal Dominant) disorder caused by proliferate lesions ( Hyperplasia , Adenoma, carcinoma) of multiple endocrine glands.

✅Cause:

➡️Mutation in the MEN1 tumor suppressor gene on chromosome 11q13, which encodes the protein menin.

💡Mnemonic:

❤️MEN1 ➡️ “3 Ps” ✔️Parathyroid ✔️Pancreas ✔️Pituitary

1️⃣ Parathyroid Glands:

✅ Most common manifestation (>90%) ⏺️ Usually due to: • Hyperplasia • Adenoma ⤵️ Causes Primary Hyperparathyroidism ⚠️Results: • ↑ PTH • ↑ Calcium (Hypercalcemia) ✅ Symptoms: • Kidney stones • Bone pain • Fatigue • Depression & psychiatric symptoms

2️⃣ Pancreatic / Enteropancreatic Tumors

📳 Functional neuroendocrine tumors ( leading Cause of death in MEN1) 💡Common types: ✅Gastrinoma ➡️Secretes Gastrin 💭Causes: ⏺️Zollinger–Ellison Syndrome • Recurrent peptic ulcers • Severe gastric acid secretion • Diarrhea ✅ Insulinoma ➡️Secretes Insulin 💭Causes: • Hypoglycemia • Sweating • Tremors • Confusion ✅ VIPoma ➡️Secretes VIP (vasoactive intestinal peptide) 💭Causes: • Watery diarrhea • Hypokalemia • Achlorhydria ❓Known as: WDHA Syndrome

3️⃣ Pituitary Tumors

Occur in about 40% of patients 💡Most common: Prolactin _Secreting Macroadenoma ➡️Secretes Prolactin 💭Causes: • Amenorrhea • Galactorrhea • Infertility

✔️Diagnosis:

❗️Genetic testing for MEN1 mutation ❗️Hormonal studies: • Calcium • PTH • Gastrin • Prolactin ❗️Imaging: • MRI • CT scan

❤️ Treatment:

⚠️ Surgery is the main treatment ( Parathyroidectomy ) ✅ Medications may control hormone excess: • PPIs for gastrinoma • Dopamine agonists for prolactinoma ------------------------------------------------------ https://t.me/Clinicalsurgeryround

الـAI مش بس عشان يلخص لك المحاضرة 👀 تقدر تخليه يرسم، يقارن، يرتّب، ويحوّل المعلومة لشيء أسهل تفهمه وتتذكره. ولو حابب الأكواد اللي استخدمتها دوس هنا https://drive.google.com/file/d/18Mv7zzF24uiemgTiJoYybHSMh2TVYfei/view?usp=drivesdk ➖️ وشاركوه لزملائكم 📝 https://t.me/Clinicalsurgeryround

🔻 Laparotomy..

⚡️ Definition :

هي عملية جراحية كبرى Major abdominal surgery يتم فيها إجراء شق جراحي في جدار البطن Abdominal wall incision بهدف الوصول إلى التجويف البريتوني Peritoneal cavity لاستكشافه أو علاج حالة مرضية داخل البطن..

وينقسم إلى قسمين :

➡️Exploratory laparotomy. ➡️Therapeutic laparotomy.

⚡️Indications :

🔹Surgical emergencies : 🔹Acute intestinal obstruction انسداد معوي حاد. 🔹Perforated viscus انثقاب أحشاء البطن مثل المعدة أو الأمعاء. 🔹Peritonitis التهاب الصفاق. 🔹Intra-abdominal hemorrhage نزيف داخل البطن. 🔹Trauma (blunt or penetrating abdominal injury) إصابات البطن الرضّية أو النافذة. 🔹Adhesion resulting from any previous surgical intervention التصاق نتيجة أي تدخل جراحي سابق. 🔹 Gastrointestinal diseases : 🔹Appendicitis complicated التهاب زائدة معقد أو منثقبة. 🔹Bowel ischemia or necrosis نقص تروية أو غرغرينا معوية. 🔹Tumors of gastrointestinal tract أورام الجهاز الهضمي. 🔹Diagnostic purpose : الاستقصاء الجراحي وهو يتم عند عدم تشخيص الحالة سريريًا أو شعاعيًا مثل : 🔹Acute abdomen of unknown cause. 🔹Gynecological causes : 🔹Ovarian torsion التواء المبيض. 🔹Ruptured ectopic pregnancy الحمل خارج الرحم المنفجر. 🔹Large pelvic masses ورم في الحوض.

⚡️Surgical technique :

🛸 التخدير ويكون : 🔹General anesthesia (GA) مع intubation endotracheal. 🔪 الشق الجراحي : 🔹Midline incision وهو الأكثر شيوعًا.. 🔹من xiphoid process إلى symphysis pubis. 🔹أو من supraumbilical إلى infraumbilical. يتم عبر linea alba 🔽 ميزته : سريع + minimal bleeding + واسع المجال.. 🔹Paramedian incision. جانبي عن الخط الناصف يعطي قوة إغلاق أفضل لكنه أقل استخدامًا حاليًا..

⚡️Intra-abdominal exploration :

بعد فتح البطن يتم : 🔹Systematic exploration of abdominal organs استكشاف اعضاء البطن. 🔹Suction of fluid / blood شفط السوائل او الدم. 🔹Identification of pathology تحديد المرض. ⚡️Surgical intervention : 🔹Resection استئصال. 🔹Repair خياطة. 🔹Hemostasis إيقاف النزيف. 🔹Lavage غسل البطن بمحلول ملحي.

⚡️Complications :

⚡️ مبكرة : 🔹Wound infection. 🔹Hemorrhage. 🔹Dehiscence. انفكاك الجرح. 🔹Ileus شلل مؤقت للأمعاء. ⚡️ متأخرة : 🔹Adhesions التصاقات داخل البطن, وهذا بيدخله لعملية لبرتومي مرة ثانية🤷‍♂️. 🔹Incisional hernin. 🔹Chronic abdominal pain. 🔹Bowel obstruction due to adhesions. ⚡️ أخرى : 🔹Anesthetic complications مضاعفات التخدير. 🔹Deep vein thrombosis (DVT). 🔹Sepsis in severe cases.

⚡️Post-operative care :

🔹NPO initially منع الأكل مؤقتًا. 🔹IV fluids + electrolyte correction. 🔹Broad-spectrum antibiotics if infection suspected. 🔹Pain control (analgesia). 🔹Early ambulation لتقليل DVT. ------------------------------------------------------- https://t.me/Clinicalsurgeryround

🛑 Diagnostic criteria toxic megacolon: ✅ transverse colon dilatation ≥ 6 cm + signs of systemic toxicity. https://t.me/Clinicalsurgeryround

Valentino's sign (or Syndrome) in peptic ulcer disease refers to the rare presentation of right lower quadrant abdominal pain due to a perforated ulcer, where gastric/duodenal contents leak down the right side, mimicking acute appendicitis. https://t.me/Clinicalsurgeryround

⭕️We should remove the lipoma due to fear of progression to sarcoma in the following sites Retroperitoneum Thigh Shoulder #general_notes

Abscess should  be drained even in the brain except some abcess treated by aspiration rather than by incision and drainage: ABCD ⚠️Amoebic abcess ⚠️Brain abcess ⚠️Cold abscess ⚠️Deep abcess https://t.me/Clinicalsurgeryround

SEPSIS – FIRST LINE DRUGS (ICU) | “Sepsis is a medical emergency. Early antibiotics save lives — start treatment within one hour of diagnosis. For empirical coverage, first-line choice is Piperacillin–Tazobactam, given as 4.5 grams IV every 6 hours, covering Gram-positive, Gram-negative, anaerobes, and Pseudomonas. In severe sepsis or septic shock, especially when resistant organisms are suspected, Meropenem is preferred at 1 gram IV every 8 hours, and in critically ill patients, the dose can be increased to 2 grams every 8 hours. For community-acquired sepsis, including pneumonia, urinary tract infection, or abdominal infection, Ceftriaxone 2 grams IV once daily is an effective option. If MRSA or line-related sepsis is suspected, add Vancomycin, at 15 to 20 mg per kg IV every 8 to 12 hours, with a target trough level of 15 to 20 micrograms per milliliter. Alternatively, Linezolid 600 mg every 12 hours, IV or oral, is useful in MRSA, VRE, and severe lung infections. In septic shock, start Norepinephrine infusion at 0.05 to 0.1 micrograms per kg per minute, and titrate to maintain a MAP of at least 65 mmHg. If shock remains refractory, give Hydrocortisone 50 mg IV every 6 hours. Initial fluid resuscitation should be 30 ml per kg of crystalloids. Remember — Early recognition, early antibiotics, and early vasopressors save lives.” https://t.me/Clinicalsurgeryround

Clinical Guide to Cervical Lymph Node Level ..✅️

🚨 7 Causes of #Acute_Abdomen 1️⃣ Appendicitis 🔹 Periumbilical → RIF pain 🔹 Nausea, fever 💎 McBurney tenderness 2️⃣ Cholecystitis 🔹 RUQ pain 🔹 Fever, vomiting 💎 Positive Murphy sign 3️⃣ Pancreatitis 🔹 Severe epigastric pain → back 🔹 Nausea, vomiting 💎 ↑ Lipase/Amylase 4️⃣ Small Bowel Obstruction 🔹 Colicky pain 🔹 Distension, vomiting 🔹 Constipation 💎 Air-fluid levels on X-ray 5️⃣ Perforation 🔹 Sudden severe pain 🔹 Guarding, rigidity 💎 Free air under diaphragm 6️⃣ Abdominal Aortic Aneurysm (AAA) 🔹 Abdominal/back pain 🔹 Pulsatile mass 🔹 Hypotension if ruptured 💎 Think AAA in older smokers 7️⃣ Mesenteric Ischemia 🔹 Severe pain out of proportion 🔹 Nausea, vomiting 💎 AF + raised lactate ⸻ 🩺 Acute Abdomen Approach ➊ History Pain site, onset, radiation ➋ Examination Vitals, guarding, rigidity ➌ Investigations FBC, CRP, LFT, Lipase, Lactate US/CT Abdomen ➍ Management IV fluids → Analgesia → Surgical review ⸻ 🚩 Red Flags 🔴 Shock/Hypotension 🔴 Guarding & Rigidity 🔴 Persistent Vomiting 🔴 Fever & Tachycardia 🔴 Abdominal Distension ⸻ 🧠 Mnemonic: ACPSPAM A – Appendicitis C – Cholecystitis P – Pancreatitis S – SBO P – Perforation A – AAA M – Mesenteric Ischemia ⸻ https://t.me/Clinicalsurgeryround

Bowel Anastomosis

🚫Don't wait abcess to fluctuate in 4p areas: ⚠️Perianal abcess . ⚠️Parotid abcess . ⚠️Palm abcess . ⚠️Breast abcess . Why we should interfere as early as possible ? To avoid destruction of nearly important structures (bone,nerves,sphincter) #surgery https://t.me/Clinicalsurgeryround

LRINEC SCORE (Laboratory Risk Indicator for Necrotizing Fasciitis) A low LRINEC score should never delay surgical consultation if clinical suspicion is high. Red flags include: 🚩Pain out of proportion to examination 🚩Rapidly progressive swelling or erythema. 🚩Skin discoloration, bullae, or crepitus. 🚩Signs of systemic toxicity or septic shock. #surgery https://t.me/Clinicalsurgeryround

The Forrest classification of bleeding peptic ulcer 🩸🩸🩸 https://t.me/Clinicalsurgeryround

Relief chest puncture is an emergency procedure indicated in tension pneumothorax. It consists of inserting a large-bore catheter (14G or larger) into the 2nd intercostal space, in the mid-clavicular line, to release the air accumulated under pressure in the pleural cavity. It should be performed immediately upon clinical suspicion, without waiting for tests, and always followed by chest drainage, which constitutes the definitive treatment. https://t.me/Clinicalsurgeryround

How to mark Lanz incision ?? Surgical landmark