Act as a Surgeon 🧠🔪

💢RetroSternal Goitre ▪︎Substernal (retrosternal) goiter, is an enlarged thyroid gland that grows inferiorly and passes through the thoracic inlet into the thoracic cavity. 🔹Can be detected clinically by Pemberton maneuver ▪︎The Pemberton maneuver is a physical examination tool used to demonstrate the presence of Mass pressure in the thoracic inlet. ▪︎The maneuver is achieved by having the patient elevate both arms ▪︎A positive Pemberton's sign When there is facial congestion and cyanosis, as well as respiratory distress after one minute. (Superior Vena Cava Syndrome) ▪︎Due to Compression of the superior Vena cava by the enlarged thyroid Goiter. 🔹Dullness On Percussion over the Sternum ➡️ Indicate Retrosternal Mass

SIRs > Sepsis > Severe sepsis > Septic shock #مهم

Difference between Fistula & Sinus

#Ulcers

✦ Features of arterial, venous, and neuropathic ulcers

هذا هو الشيت

Open-heart surgery: It is a surgical procedure in which the chest is opened to access the heart. It is performed for various medical reasons. Modern techniques may also be used, allowing surgery through a small incision without the need for a large chest incision, often using a camera. #surgery

Allen test: A simple clinical test used to assess the patency of the radial and ulnar arteries and the adequacy of collateral circulation before radial artery cannulation or arterial sampling. #surgery

➖➖➖➖➖🔳➖➖➖➖➖ 🟠 Cullen's sign :     is a physical exam finding of ecchymoses, or bruising, around the umbilicus. This sign indicates either intraperitoneal or retroperitoneal hemorrhaging. ▪️D.D : 1.acute cholecystitis 2. bowel obstruction or infarction. 3. perforated viscus. 4. renal colic. 5. duodenal diverticulitis. 6. aortic dissection. 7. appendicitis. 8. ruptured abdominal aortic aneurysm ➖➖➖➖➖🔳➖➖➖➖➖

🫀 CABG – Coronary Artery Bypass Grafting What is CABG? Coronary Artery Bypass Grafting (CABG) is a surgical procedure used to improve blood flow to the heart in patients with severe coronary artery disease (CAD). It creates a new pathway for blood to bypass blocked or narrowed coronary arteries. 🔬 How is it performed? A healthy blood vessel is taken from another part of the body (commonly the internal mammary artery, radial artery, or saphenous vein) and grafted to restore blood flow beyond the blockage. 📌 Indications for CABG: • Left main coronary artery disease • Triple-vessel coronary artery disease • Severe proximal LAD stenosis • Failed or unsuitable PCI • Diabetes with multivessel CAD (selected cases) ⚠️ Potential Risks: • Bleeding • Infection • Stroke • Arrhythmias • Graft occlusion 💙 Benefits: ✔ Relief of angina symptoms ✔ Improved myocardial perfusion ✔ Better quality of life ✔ Reduced cardiovascular events in selected patients 🩺 Post-operative Care: • Cardiac rehabilitation • Lifestyle modification • Antiplatelet therapy • Lipid control and risk factor management “CABG remains one of the most effective revascularization strategies for complex coronary artery disease.” Prepared by: Dr. Malak Heyal ✨

Tracheostomy Tubes 🔹Metallic (3 Parts) •Outer Cannula ➡️ Fixed to the neck •Inner Cannula ➡️ For cleaning •Obturator ➡️ For Easy Insertion 🔹Plastic (1 Part) Indications of Temporary Tracheostomy 1. Upper air way obstruction 2. Tracheo-bronchial toilet 3. Pulmonary ventilation 4. Adjuvant to neck surgery 5. Reduce the dead space 6.Airway protection in head injured or comatose patient Indications of permanent Tracheostomy 1.Laryngeal Carcinoma Contraindications 1. Unstable cervical spine 2. Uncorrected coagulopathy 3. neck mass or pervious neck surgery 4.mediastinal irradiation 5. Previous surgical tracheostomy Advantages of Tracheostomy ▪ Increased patient mobility ▪ More secure airway ▪ Increased comfort ▪ Improved airway suctioning ▪ Early transfer from ICU ▪ Less endo-laryngeal injury ▪ Enhanced oral nutrition ▪Enhanced phonation ▪Decreased airway resistance ▪Decreased risk for nosocomial pneumonia

Ranson's criteria &Scoring system assess the prognosis of acute Pancreatitis (give every criteria one point ) #مهم

JJ stent ▪︎Indications 1.Relief Obstruction From ureteric Stones/Strictures 2.Prevention of obstruction After ureteroscopy 3.After Ureteric injury 4.After Large residual stone 5.Before ESWL 6.For Passive dilatation of the ureter Before ureteroscopy 7.After renal surgery to ensure Antegrade flow of urine (e.g. pyeloplasty )

suprapubic cystostomy ▪︎indications 1. Failed urethral catheterization 2. Urethral disruption 3. Long-term bladder drainage ▪︎Contraindications 1. Non-palpable bladder 2. Previous lower abdominal surgery 3. Coagulopathy 4. Known bladder tumour 5. Clot retention

Foley Catheter 🔹indications of use : ▪︎one way :- -in CIC  (clean intermittent catheterization) ▪︎two way :- ○Diagnostic  : •Urine collection (measurements Of Urine Output & residual volume) ○therapeutic : •Relive Acute urinary retention •During Urologic & Contiguous Surgery (To Prevent Urine leakage by accident) ▪︎three way :- •Bladder Irrigation After Bleeding (Clots Present) •injection Of AB & Chemotherapy & Contrast •Urodynamic and Cystography 🔹Long Term Catheterization For 1. Refractory urine retention (not correctable) 2. Neurogenic bladder 3. Incontinence 🔹Contraindications 1. Suspected Urethral injury 2. Urethral Strictures 3. Urethral Sepsis 4. High Riding Or Detached Prostate 5. Difficult Insertion For Other Reasons 🔹Complications 1. Inability to catheterize 2. Infection 3. Urethral injury/Stricture 4. Psychological trauma 5. Paraphimosis 6. Hematuria 7. Stone Formation 8. Allergy or sensitivity to latex 9. Bladder cancer (After long-term Use)

Foley Catheter 🔹1-Way urinary catheters ▪︎have only one channel for passage of urine. Like CIC  (clean intermittent catheterization) 🔹2-Way urinary catheters ▪︎The most Commonly Used ▪︎Have two channels: one channel is for the passage of urine and the other for balloon inflation and deflation. 🔹3-Way urinary catheters ▪︎available with a third channel to facilitate continuous bladder irrigation ▪︎primarily used After urological surgery or in case of bleeding from a bladder or prostate, For continuous or intermittent irrigation to clear blood clots or debris. 🔹Duration ▪︎7-10 days for latex ▪︎1 month for the silicon 🔹Alternative way ▪︎suprapubic cystostomy ▪︎Catheter Length 40-45 cm ▪︎Recommended Use The Smallest Size ▪︎Most Common Materials ➡️ Silicon/Silicon Coated Latex ▪︎Size Measurement By French (1FR=3mm)

Amyand hernia >> contain appendix Litter hernia >> contain meckel diverticulum Richter hernia >> only antimesntric wall Pantaloon hernia >> both direct and indirect Sliding hernia >> loop is part of the posterior wall Maydl hernia >> M shaped loop #hernia