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Alvarado score for appendicitis #ClinicalSurgery

♦️hiatal hernia occurs when part of the stomach pushes upward through the diaphragm (the muscle that separates the chest from the abdomen) into the chest cavity. Types Sliding hiatal hernia (most common) The stomach and the junction between the esophagus and stomach slide up into the chest. Often associated with acid reflux. Paraesophageal hiatal hernia Part of the stomach pushes through the diaphragm beside the esophagus. Less common but can be more serious because the stomach can become trapped. Diagnosis using: Upper endoscopy Barium swallow X-ray Esophageal manometry Treatment Lifestyle changes Eat smaller meals Avoid lying down for 2–3 hours after eating Lose excess weight if needed Elevate the head of the bed Avoid trigger foods (fatty foods, caffeine, alcohol, spicy foods) Medications Antacids H2 blockers Proton pump inhibitors (PPIs) Surgery for severe symptoms complications, or large paraesophageal hernias. Common procedure: laparoscopic repair, often with fundoplication. #Clinicalsurg.

$ 🔴 Tokyo Consensus Guidelines In Acute Cholecystitis 🔴 $ ⏺ The Tokyo Guidelines (specifically the TG18/TG13 updates, which remain the clinical standard) provide a highly structured framework for diagnosing and grading the severity of acute cholecystitis (gallbladder inflammation) 🩺. ⏺ Tokyo Consensus Guidelines diagnostic criteria for acute cholecystitis : A. Local signs of inflammation, etc. 📍 1) Murphy's sign 2) Right upper quadrant pain/tenderness/mass. B. Systemic signs of inflammation, etc. 🌡️ 1) Fever 2) Elevated CRP 3) Elevated WBC count. C. Imaging findings 🖼️ Imaging findings characteristic of acute cholecystitis. ❕Suspected diagnosis: 1 item in A + 1 item in B ❗️Definite diagnosis: 1 item in A + 1 item in B + C. ...................................... ⏺ Tokyo Consensus Guidelines for severity grading of acute cholecystitis : 📊 •Grade III (severe) acute cholecystitis ; Associated with dysfunction of any one of the following organs/systems: 🚨 1. Cardiovascular dysfunction Hypotension requiring treatment with dopamine ≥5 μg/kg/min, or any dose of epinephrine. 2. Neurological dysfunction Decreased level of consciousness. 3. Respiratory dysfunction PaO2/FiO2 ratio <300 4. Renal dysfunction Oliguria; creatinine >2.0 mg/dL 5. Hepatic dysfunction Prothrombin time (PT-INR) >1.5 6. Haematological dysfunction Platelet count <100 000/mm3 • Grade II (moderate) acute cholecystitis ; Associated with any one of the following conditions: 🟠 1. Elevated white cell count (>18 000/mm3) 2. Palpable tender mass in the right upper abdominal quadrant. 3. Duration of complaint >72 hours 4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis) • Grade I (mild) acute cholecystitis ; Does not meet the criteria of grade II or grade III acute cholecystitis. Grade I can also be defined as acute cholecystitis in a healthy person with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure. ✅ #Clini@clinicalsurg

Pressure Ulcer

#Surgery

✨Different between shifted , radiated and referred pain : ◾| Shifted pain A disappear pain from original site and reappearing  in another site ex : appendicitis ◾| Referred pain pain that is felt at a distance from it's source (no anatomical communication) Ex cholecystitis ◾ | Radiated pain Communication b/w original site and new site يكون ماسك مثل الحزام

⭕️Wagner Classification of Diabetic Foot 🔻Grade 0 Intact skin with high-risk foot (deformity, callus, previous ulcer) 🔻Grade 1 Superficial ulcer involving skin only 🔻Grade 2 Deep ulcer extending to tendon, ligament, joint capsule, or fascia (no abscess or osteomyelitis) 🔻Grade 3 Deep ulcer with abscess, osteomyelitis, or septic arthritis 🔻Grade 4 Localized gangrene (forefoot or heel) 🔻Grade 5 Extensive gangrene involving the whole foot

📌 Femoral canal , sheath,  traingle , ring

🔻X-ray sign: Coffee bean sign. or Bent Inner Tube Sign 🔻Diagnosis: Sigmoid volvulus.(Intestinal obstruction) 🔻Initial treatment: Endoscopic decompression. (flexible sigmoidoscopy ± rectal tube) if there is no evidence of bowel ischemia, perforation, or peritonitis. 🔻Definitive treatment: Elective sigmoid colectomy after successful decompression (to prevent recurrence), or emergency surgery if endoscopic decompression fails or if bowel ischemia, gangrene, perforation, or peritonitis is present

Complications of Subarachnoid Hemorrhage (SAH) Early 1. Rebleeding ⭐ 2. Cerebral Vasospasm ⭐⭐⭐ Day 3–14 Peak around Day 7 3. Hydrocephalus #

Indications for Prophylactic Anticonvulsants 1-Severe injuries(GCS ≤8) 2-Depressed skull fracture 3-Penetrating brain injury 4-Intracranial hematoma (EDH, SDH, ICH) 5-Cortical contusion 6-Previous post-traumatic seizure 7-Craniotomy after trauma 8- elderly 9- alcoholic patients 10- loss of consciousness more than 5 minutes #

Indications for Prophylactic Anticonvulsants 1-Severe injuries(GCS ≤8) 2-Depressed skull fracture 3-Penetrating brain injury 4-Intracranial hematoma (EDH, SDH, ICH) 5-Cortical contusion 6-Previous post-traumatic seizure 7-Craniotomy after trauma 8- elderly 9- alcoholic patients 10- loss of consciousness more than 5 minutes #