Helpers SEM 6

تجميعة اسكيمة ل examination هترتب دماغكم في الجراحة من زميلنا جزاه الله خير الفيديو متسرع على 2

اسئلة السنين السابقة مش بيطلع منها وعد بإذن الله اكتر من 95 % مع تعلن الاكزامينيشن دكتور احمد كامل كان عاملها لكن من دون اجابات فأنا جمعتها بالإجابات والحاجات اللي عاوزين يسمعوها منكم في الاوسكي يغني عن المزاكرة النظري بشكل كبير جداً ادعولي بطمأنينة القلب انا وأهلي

لو حد مزنوق جدا وعاوز بفضل ربنا يضمن 90 % من امتحان الباطنة بأقل مجهود وتركيز ع المهم . تعبت جدا لما جمعتهم دول عباره عن كل اللي جه ل 61 وايه المهم وايه لا والاسئله متجاوب عليها مع تركيزات الميتينج اتمنى تدعولي كتير

Abdominal Examination Round ⁃ examine the abdomen (abdominal mass, etc.) ⁃ You have to ask general or local (often forgotten) ⭐️ ⁃ Local examination ⁃ Stand on the right side ⁃ Say hi to the patient ! ⁃ Verbal consent [not written] ⁃ Exposure ⁃ Patient position (abdominal examination -> supine (mainly) and knee is slightly flexed to relax abdominal muscles and feel spleen and feel masses???) - digital rectal examination (from supine to left lateral) Main-> Inspection, palpation, percussion Additional: ⁃ Digital rectal examination ⁃ Back of the patient ⁃ Back of the spine ⁃ Back of scrotum Inspection ⭐️ ⁃ Look ay the abdominal contour ⁃ Movement with respiration ⁃ Anatomical points (costal margin umbilicus suprabupic hair dilated veins stria) Palpation ⭐️ ⁃ Superficial ⁃ tenderness (you look the at patient’s face while palpating if he’s in pain theres tenderness) ⁃ Rebound tenderness -> comes after you remove your hand ⁃ Signs of peritoneal irritation or per ⁃ tenderness, rebound tenderness, rigidity 🫪 ⁃ Deep ⁃ Organs and masses ⁃ Liver, spleen, kidney, colon (organs palpaed in the abdomen) ⁃ Say 2 only so he doesn’t ask you 5alas b2a say how to palpate the kidney ⁃ When is the gall bladder palpable? When it’s obstructed Percussion ⁃ Resonance, dull percussion of ascites, etc. ⁃ Dull -> in obstruction Auscultation ⁃ For abdominal sounds ⁃ Intestinal obstruction-> hyper-audible • Hyper-audible -> mechanical intestinal obstruction • Lost or no sound -> paralytic ileus (usually secondary to peritonitis/ inflammation) ————— Spleen from right iliac fossa to the right? Border of the spleen Items that are specific to the PAIN!! in present history (other than onset coarse duration…) ⁃ SITE ⭐️ ⁃ Character (cholicy..) Any symptom in surgery: Lump -> complain Swelling -> present history Disturbance of function Calcular or non-calcular to know if you’ll do US Calcular in 80% of patients Abdominal US ⭐️!! (Gives you the mark) ⁃ What is the next step in work up that would confirm diagnosis ? US !! ⭐️- diagnostic test of choice ⁃ US Describes gall bladder and things associated with it and most importantly the biliary cyst ⁃ US shows biliary system, liver, pancreas since they could have complications because of calcular cholecystitis Lab is the Second choice ⁃ CBC ⁃ Liver function ⁃ Amylase Liver function tests Bilirubin (total and direct) ⭐️ Alkaline phosphatase (AP) Gamma glutamyl transferase (GGT) AP and GGT increase only in inflammation of biliary epithelium due to the stones passing ⁃ Mild elevation (acute cholecystitis), but if severe (thousands) -> pathology isn’t in gall bladder it’s in liver ⁃ Lipase is more specific than amylase ⭐️ ⁃ Lipase rules out pancreatitis ? ⁃ Provisional -> after history and examination ⁃ Investigation -> diagnosis ⁃ Surgery and sample ? -> definitive diagnosis What’s the difference between obstructive jaundice and cholangitis ? Jaundice ⁃ Pain and jaundice Cholangitis ⁃ patient presents with sepsis so you have to be quick and tl7a2o Cholangitis is originally -> obstructive jaundice + infection fever, tenderness in right hypochondria (charcott’s triad) Hypotension and fever -> cholangitis complicated with septic shock Presentation of patients with gall stones ⭐️ Pancreas and gallstone ileus are commonly forgotten Gall stone ileus (question of full mark) - gall stone MECHANICAL ILEAL SMALL INTESTINAL OBSTRUCTION is the correct name Most catastrophic complication of gall bladder stone is cholangitis ⭐️!!! Early laparoscopic cholecystectomy is the solution now Prophylactic cholecystectomy ⁃ Diabetic ⁃ Immunocompromised ⁃ Renal transplant ⁃ Typhoid (added by dr) Treat without operation WHEN? ⁃ patient unfit for surgery and anesthesia

نوتس الدكتور ركز عليها في راوند الulcer

. 1) Pleomorphic Adenoma (Mixed Parotid Tumor) Features Most common salivary gland tumor. Usually parotid gland. Encapsulated but incomplete capsule. Multicentric (satellite nodules). Clinical picture Painless. Slowly growing. Well defined swelling. Elevation of ear lobule. No facial nerve affection. Investigations U/S, CT, MRI. FNAC. Treatment Superficial conservative parotidectomy. Total conservative parotidectomy if deep lobe involved. ⸻ 2) Warthin Tumor Origin Epithelial tumor arising in parotid lymph node. Incidence Old males >50 years. 10% of parotid tumors. 10% bilateral. Clinical picture Painless. Slowly growing. Lower pole of parotid. Does not elevate ear lobule. Treatment Enucleation. ⸻ 3) Malignant Salivary Gland Tumors Features Non-capsulated. Fixed. Perineural invasion. Facial nerve palsy may occur. Treatment Surgery Total radical parotidectomy. Facial nerve sacrifice if infiltrated. LN dissection if needed. Radiotherapy ⸻ 4) Acute Sialadenitis Causes Ascending infection through duct. Clinical picture Painful swollen gland. Fever. Tenderness. Treatment No abscess Oral hygiene. Fluids. Lozenges. Antibiotics (Clindamycin). Abscess Incision and drainage. ⸻ 5) Chronic Sialadenitis Causes Recurrent inflammation. Stones. Symptoms Recurrent pain during meals. Signs Enlarged tender gland. Stone may be palpable. Investigation X-ray: Radio-opaque stone. Treatment Duct stone → Sialendoscopy. ⸻ 6) Sialolithiasis Definition Salivary gland stones. Common site Submandibular gland (80%). Clinical picture Meal time syndrome. Pain increases during eating. Swelling. Investigations X-ray. U/S. Treatment Small stone Conservative. Impacted stone Sialendoscopy. Large stone Surgical removal. Recurrent disease Sialadenectomy. ⸻ 7) Sjogren Syndrome Definition Autoimmune sialadenitis. Clinical picture Xerostomia. Xerophthalmia. Dry mouth. Dry eyes. Arthritis. Investigations RF positive. Hypergammaglobulinemia. Schirmer test. Treatment Artificial tears. Fluids. Steroids. ⸻ 8) Thyroglossal Cyst Features Midline neck swelling. Moves with swallowing. Moves with tongue protrusion. Symptoms Dysphagia. Dyspnea if large. Treatment Sistrunk operation. ⸻ 9) Branchial Cyst Site Anterior border of upper and middle third of SCM. Features Soft. Smooth. Slow growing. Painless. No movement with deglutition. Treatment Surgical excision. ⸻ 10) Ranula Definition Mucous retention cyst of sublingual gland. Clinical picture Bluish. Fluctuant. Frog belly appearance. Slow growing. Treatment Excision of ranula + sublingual gland. حفظة ليلة الامتحان لو الوقت ضيق جدًا: Pleomorphic adenoma Warthin tumor Sialolithiasis Acute sialadenitis Sjogren syndrome Thyroglossal cyst .

#Surgery_GIT_L2

#Surgery_GIT_L9

بصمجوا رانسون مهمة

Eraky Mnemonic For Ranson criteria يحكي رانسون : وأنا سني ٥٥ كان عندي ولد أبيض عنده ١٦ سنة سكره كان بيعدي المتين قلتله ظبط أكلك ياض قالي يا أسطى (AST) دا بيعدي ال ٢٥٠ قلتله لا ده (LDH ) كده هيعدي ال ٣٥٠ قاعد جوعان ( base deficit) أكلت فطيرة ( BUN increase) وشربت عصير ( fluid deficit ) قلت لهم كفاية عصير أنا عاوز كالسيوم عشان هكت (Hct decrease) من هنا عشان مفيش أكسجين في المكان ٤ ٥ ٦ ٨ ١٠ ٦٠