Act as a Surgeon 🧠🔪

🔶D. Epigastric Hernia

▪︎Elliptical Bulging Through The MidLine Raphe (Linea Alba) Midway Between Xiphoid Process & Umbilicus ▪︎Due To Small Blood Vessels Piercing Linea Alba Or Abnormal Decussation Of Aponeurotic Fibers Or After Heavy Physical Activity ▪︎More in Men (25-40 Years) ▪︎Multiple Epigastric Hernia May Present At Same Time (Leads To Recurrence After Tx) ▪︎Present As Painful Small Swelling in Midline Can Be Felt More Than Seen (DDX Peptic Ulcer/Lipoma) ▪︎Narrow Neck (Risk Of Strangulation)

🔶E. Incisional Hernia

▪︎Bulging Through Postoperative Scar in The Abdominal Wall ▪︎More With Laparotomy Incisions (10-50%) ▪︎Wide Neck (Low Risk Of Strangulation) ▪︎Mx Mostly By Wearing Abdominal Binder Or Belt To Prevent Hernia From Increase in Size

🔹Risk Factors For Incisonal Hernia

1. Obesity/Chronic Cough/Cancer 2. Poor Wound Healing (Due To Immunosuppression/Steroids/Malnutrition) 3. Wound Infection/Poor Tissue Quality 4. Inappropriate Suture Materials/Incorrect Suture Placement

🔹Present As

1. Multiple Bulging Defects At Scar Site With Serosanguineous Discharge 2. Increase in Size Over Time 3. Skin Atrophy & Visible Bowel Peristalsis/Skin Dermatitis (Due To Vascular Damage) 4. Partial Bowel Obstruction (Internal Adhesions)

🔹Prevention Of Incisonal Hernia

1. Weight Loss & Nutritional Improvement 2. Using Non Absorbable Or Very Slowly Absorbable Sutures 3. Using Suture Length To Wound Length 4:1 (Jenkins's Rule) 4. Drains Placed At Separate Incision 5. Use Prophylactic Mesh

🔶F. Sportsman's Hernia

▪︎Severe Chronic Pain At Groin Region Extending Into The Scrotum & Upper Thigh With Tenderness Over The Pubic Tubercle & Inguinal Canal & Adductor Muscle Insertion  ▪︎Seen in Young Men Playing Contact Sports (Football & Rugby) ▪︎Due To ➡️ Orthopedic Injuries (Adductor Strain/Pubic Symphasis Diastasis)/Muscle Tears/Stretching The Posterior Wall Of Inguinal Canal

🔶G. Spigelian Hernia

▪︎Defect in Spigelian Fascia (Aponeurosis Of Transversus Abdominis Muscle) Results in Bulging Below The Umbilicus Near The Edge Of Rectus Sheath ▪︎More in Elderly ▪︎Mostly Contain ExtraPeriToneal Fat ▪︎Present As Intermittent Pain (Like Epigastric Hernia) Or Reducible Swelling At Edge Of Rectus Sheath With Bowel Obstruction ▪︎Narrow Neck (Risk Of Strangulation) https://t.me/Clinicalsurgeryround

🔰Complications Of Hernia

📍A. Preoperative 1. Irreducible Hernia Then Strangulation Then Infarction 2. Bowel Obstruction 3. Discomfort & Disfiguring 📍B. Postoperative 1. Bleeding (Damage To Inferior Epigastric Or Iliac Vessels) 2. Urine Retention 3. Femoral Nerve Anesthesia (Patient Unable To Move A Leg That Resolve Spontaneously in 12h) 4. Seroma Formation (Clear Fluid Accumulation Under The Skin Due To Inflammatory Response To Mesh & Sutures) 5. Wound Infection 6. Hernia Recurrence 7. Chronic Pain (Pain Present 3m After Surgery) 8. Testicular Atrophy (Damage To Testicular A is Most Serious Complication)

🔰Types Of Hernia

🔶A. Inguinal Hernia ▪︎Most Common Type Of Hernia in Males ▪︎More On Right Side ▪︎Present As Bulging At Inguinal Region Above & Medial To Pubic Tubercle (Above Inguinal ligament)

🔹Types Of Inguinal Hernia

📍1. Indirect (Congenital/Oblique/Lateral) مال الأطفال ▪︎Most Common Type Of Inguinal Hernia ▪︎Present in Neonates & Young Children (Seen At Birth) ▪︎Due To Congenital Failure To Obliteration Of Tunica Vaginalis ▪︎Originates Lateral To Inferior Epigastric Vessels Then Pass Through The Internal & External Inguinal Rings (Following The Same Course Of Spermatic Cord) تمر بالفتحة الداخلية والخارجية وتروح للسكروتم مثل السبرماتك كورد ▪︎Results in Bowel Pass Through Inguinal Canal Into The Scrotum (Scrotal Hernia) ▪︎Can Controlled By Pressure Over Internal Inguinal Ring ▪︎Reduciable But Has Narrow Neck (More Risk Of Strangulation Than Direct) ▪︎Reduced Upwards-Laterally-Backwards ▪︎Reappears At Middle Of Inguinal Region Then Medially ▪︎The Defect Not Palpable Over The Abdominal Wall (Covered By External Oblique Muscle) 📍2. Direct (Acquired/Medial) الكبار اهل الميديل ▪︎Present More in Elderly ▪︎Due To Weakness & Stretching Of Abdominal Wall ▪︎Medial To Inferior Epigastric Vessels ▪︎Protrude Through HasselBach's Triangle (Weak Area Consists Only Of Transversalis Fascia & External Oblique Aponeurosis) Then Emerges From The External Inguinal Ring تمر فقط بالفتحة الخارجية ▪︎Not Controlled By Pressure Over Internal Inguinal Ring ▪︎Wide Neck & Reduciable (Low Risk Of Strangulation) ▪︎Reduced Upwards-Straight Backwards ▪︎Reappears At Same Position ▪︎Defect Felt In Abdominal Wall Above The Pubic Tubercle 📍3. Sliding Hernia (Acquired But in Lateral Position) ▪︎Due To Weakness Of Abdominal Wall At Deep Inguinal Ring Lateral To Inferior Epigastric Vessels ▪︎Results in Bowel Bulging Through The Hernia (Caecum On Right & Sigmoid Colon On Left) ▪︎Risk Of Bowel Injury During Repair 📍4. Pantaloon Hernia ➡️ Both Lateral & Medial Hernia Present At Same Time

🔶B. Femoral Hernia

▪︎Hernia Present As Bulging In Upper Legs Below & Lateral To Pubic Tubercle (Below Inguinal Ligament) ▪︎More in Low Weight Elderly Women (Due To Large Femoral Canal) ▪︎Small Size & Easily Missed ▪︎Very High Risk Of Strangulation & Small Bowel Obstruction Due To Narrow Neck (50% Emergency) ▪︎DDX ➡️ Direct Inguinal Hernia/Inguinal Lymph Nodes/Femoral A Aneurysm/Saphena Varix/Psoas Muscle Abscess/Adductor Longus Muscle Rupture With Hematoma

🔶C. Umbilical Hernia

🔺in Children (Most Common) ▪︎Conical Shape Small Sac Protruding Through The Umbilicus Due To Delayed Closure Of Umbilical Defect ▪︎Increase in Size During Crying ▪︎More Common in Premature Black Infants ▪︎Mostly Resolve Spontaneously (95%) ▪︎Need Surgical Repair If Persist >2 Years Of Age 🔺in Adults (ParaUmbilical Hernia) ▪︎Crescent Shape Bulging Near The Umbilicus ▪︎More in Women ▪︎Present In Adults Due To Stretching & Thinning Of MidLine Raphe (Linea Alba) After Pregnancy Or Obesity Or Liver Disease ▪︎Narrow Neck & Contain Bowel (Risk Of Obstruction & Strangulation) https://t.me/Clinicalsurgeryround

🔴Abdominal Hernia

▪︎Hernia is Bulging Of Part Of Abdominal Contents Through Weakness in Abdominal Wall

🔹Causes & Risk Factors Of Hernia

🔶A. Anatomical Weakness Due To

📍1. Structures Entering & Leaving The Abdominal Wall ➡️ Like Inguinal/Femoral/Hiatus/Obturator/Sciatic Hernias 📍2. Developmental Failure Leads To Weakness In Abdominal Wall Muscles ➡️ Like Diaphragmatic/Umbilical/Epigastric Hernias 📍3. Failure Of Processus Vaginalis To Close ➡️ Leads To Indirect Inguinal Hernia 📍4. Genetic Weakness in Collagen

🔶B. Acquired Weakness Due To

📍1. Sharp Trauma To Abdominal Wall (Surgery Or Stabbing Injury) ➡️ Like Traumatic & Incisional Hernia 📍2. Increase IntraAbdominal Pressure (By Coughing/Straining/Prostatic Obstruction/Obesity & Abdominal Distension) 📍3. Ageing & Pregnancy 📍4. Neurological & Muscle Diseases 📍5. Rectus Sheath Hematoma 📍6. Smoking

🔹Components Of Hernia

📍A. Abdominal Wall Defect (Neck) ▪︎It's The Narrowest Part Of The Hernia Through Which The Hernia Pass ▪︎Defect in Muscle (Incisional Hernia) ▪︎Defect in Fascia (Epigastric Hernia) 📍B. The Layers Of The Abdominal Wall That Covers The Hernia (The Coverings Of The Sac) 📍C. The Sac (Peritoneal Covering) 📍D. Content Of The Sac 1. Fat ➡️ Epigastric Hernia 2. Bladder ➡️ Direct Inguinal Hernia 3. Peritoneum (Bowel/Omentum) ➡️ Sliding Inguinal Hernia

🔹Hernia Complexity

📍1. Reducible ➡️ Intraperitoneal Content Move Freely in & Out Of Hernia (Bulging Can Be Reduced) 📍2. Irreducible ➡️ Intraperitoneal Content Trapped & Can't Return To Main Peritoneal Cavity Of The Abdomen Due To Adhesions Or Narrow Neck (High Risk Of Complications) 📍3. Strangulated ➡️ Irreducible Hernia With Vascular Compromise & Ischaemia Leads To Painful Swelling (Need Urgent Surgery) راح تنلاص 📍4. Infarcted ➡️ Content Of Strangulated Hernia Become Gangrenous Leads To Bowel Perforation & Peritoneal Cavity Contamination (High Mortality) مليوصة للستار 📍5. Incarcerated ➡️ Irreducible Hernia Contain Colon & Progress Towards Strangulation حاشرة بس بعدهي ما مليوصة 📍6. Occult ➡️ Hernia Not Detectable Clinically But Causing Severe Pain

🔹Clinical Features & Examination

📍1. Most Hernias Are Painless Swelling Under The Skin 📍2. Severe Pain & Tenderness With Bowel Obstruction ➡️ Indicate Strangulation 📍3. Examination By ▪︎Site/Number/Size/Shape/Composition ▪︎Reducibility ▪︎Cough Impulse ▪︎Skin Colour Changes & Tenderness ▪︎Scar Of Previous Repair Or Other Surgery 📍4. Special Tests For Inguinal Hernia ▪︎Can't Get Above It ▪︎invagination Test ▪︎Three Fingers Test (Zieman' Test) ▪︎Ring Occlusion Test 📍5. Imaging ▪︎CT ➡️ For Incisionsal Hernia ▪︎MRI ➡️ For Sportsman's Hernia ▪︎Contrast Barium & Laparoscopy ➡️ For Inguinal Hernia

🔹Mx Of Hernia

▪︎Indications For Surgery 1. Complications Develop (Strangulation/Bowel Obstruction & Infarction) 2. Any Irreducible Hernia/Any Femoral Hernia 3. Reduciabl Hernia Increase in Size Over Time (Progress Towards Irreducible) 4. Inguinal Hernia in Children/Symptomatic Inguinal Hernia in Adults 5. Persistent Umbilical Hernia >2 Years Age 6. Cosmetic/Relief Symptoms Of Discomfort 7. Dx in Doubt

▪︎Surgery Principles

1. Content Reduction With Remove Non-Viable Tissue & Bowel Repair 2. Excision & Closure Of Peritoneal Sac 3. ReApproximation The Walls Of The Herina's Neck 4. Reinforcement Of The Abdominal Wall Defect By Mesh Or Sutures

▪︎Surgical Procedures

1. Herniotomy ➡️ Hernial Sac Removal Only 2. Herniorrhaphy ➡️ Herniotomy + Repair Of Inguinal Canal Posterior Wall 3. Hernioplasty ➡️ Herniotomy + Herniorrhaphy + Mesh Reinforcement https://t.me/Clinicalsurgeryround

🔹Mx Of Appendicitis

🔶A. Preoperative Preparation

1. Bowel Rest (Nill By Mouth) 2. IV Fluids (To Establish Urine Output) 3. IV AB (Amoxicillin/Metronidazole/3rd G.Cephalosporins Like Ceftriaxone/Ertapenem) 4. Anti-Pyretics If High Temperature Present (Aspirin For Children Or Paracetamol Vial)

🔶B. Surgical AppendiCectomy (Laparoscopic Or Conventional)

▪︎Types Of Incisions During Conventional Surgery 1. Gridiron (Most Commonly Used) ➡️ Made At McBurney's Area 2. Rutherford Morison ➡️ Give Better Access If Appendix in Para Or RetroCaecal Position 3. Transverse (Lanz) ➡️ Better Exposure & Easier Extension & Small Size 4. Lower MidLine Abdominal ➡️ When Dx in Doubt & Bowel Obstruction Present

🔶C. Mx Of Appendix Mass ➡️ According To Ochsner Sherren Regime

1. Marks & Follows The Mass Size Using Skin Pencil 2. Give IV Fuids & AB (Cefuroxime 750mg + Metronidazole 500mg) 3. Mostly Mass Resolve in 24-48h (90%) ➡️ Then Do AppendiCectomy After 6w 4. No Mass Resolution ➡️ Suspected Carcinoma Or Crohn's Disease 5. Clinical Deterioration (Mass Developed Abscess) ➡️ Do Laparotomy & Retroperitoneal Abscess Drinage & Appedicectomy

🔹Complications Of Appendicitis

🔶A. Preoperative 📍1. Perforation Of Appendix & Peritonitis Seen More in : ▪︎Extremity Of Ages (Young Child Or Elderly) ▪︎Immunosuppression & DM ▪︎Pelvic Appendix ▪︎Fecolith Obstruction Of Appendix ▪︎Previous Abdominal Surgery 📍2. Appendix Mass Formation (Due To Omental & Small Bowel Adhesions) 📍3. Appendix Abscess

🔶B. Postoperative

📍1. Wound Infection (Most Common Postoperative Complication) ➡️ Pain & Erythema At Wound Site On 4th-5th Day 📍2. Intra-Abdominal Abscess ➡️ Develop 5-7 Days After Operation As Spiking Fever With Malaise & Anorexia 📍3. Paralytic Ileus 📍4. DVT (More in Elderly & Women Taking Contraceptives) 📍5. PyleoPhlebitis (Portal Pyaemia) ➡️ High Fever With Rigor & Jaundice Due To IntraHepatic Abscess Formation 📍6. Faecal Fistula 📍7. Bowel Obstruction Due To Adhesions (Most Common Late Complication) 📍8. Pneumonitis & Lobar Collapse https://t.me/Clinicalsurgeryround

🔴Acute Appendicitis

▪︎Acute Inflammation Of Appendix After Lumen Obstruction & Bacterial Proliferation ▪︎More in Children & Young Adults (15-30 Years) & More in Males After Puberty ▪︎Most Common Cause Of Acute Abdomen in Young Adults & Most Common Surgical Emergency ▪︎Most Common ExtraUterine Cause Of Acute Abdomen During Pregnancy (More in 2nd Trimester & Has A Risk Of Fetal Loss) ▪︎Appendix is The Most Common Site For Carcinoid Tumors (Arise From Kulchitsky Cells) The Appendix is 7.5-10cm IntraPeriToneal Organ Attached To Caecum Of Large Bowel At Right Iliac Fossa

🔹Risk Factors For Appendicitis

1. Decrease Dietary Fibers & Increase Carbs Intake 2. Lumen Obstruction Of Appendix By Fecolith Or Fibrosis Or Tumors (Carcinoids in Middle Age & Elderly) 3. Intestinal Parasites (Oxyuris Vermicularis Pin Worms) 4. Viral Infections (More in Children)

🔹Position Of Appendix

📍A. Base Of Appendix ➡️ Fixed (Constant) At Confluence Of Three Taeniae Coli Of Caecum 📍B. Tip Of Appendix 1. RetroCaecal (Behind Caecum Most Common 74%) 2. Pelvic (2nd Most Common 21%) 3. ParaCaecal (2%)/SubCaecal (1.5%) 4. Postileal (Behind ileum 0.5%)

🔹Clinical Features & Dx

🔶A. Hx 📍1. Start As Poorly Localized Colicky Intermittent Abdominal Pain At PeriUmbilical Area (Visceral Pain) 📍2. Then After 6-10h The Pain Shifted To RIF & Become More Intense & Localized & Constant (Somatic Pain After Parietal Peritoneal Irritation) 📍3. Pain Aggravated By Coughing & Sudden Movements 📍4. Atypical Pain (Suprapubic Discomfort & Tenesmus Aggravated By Rectal Examination) ➡️ More in Elderly 📍5. Anorexia & Vomiting (More in Children) 📍6. Slight Pyrexia After 6h (37.2-37.7°C) & Tachycardia 📍7. Abrupt Onset & Generalised Abdominal Pain From Start With Vomiting & Normal Temperature (Resemble Bowel Obstruction) Seen in ➡️ Seen in Obstructive Appendicitis (Closed Lumen)

🔶B. Examination

📍1. Guarding ➡️ Voluntary Abdominal Muscle Contractions Due To Pain After Palpation 📍2. Rebound Tenderness (Blumberg's Sign) ➡️ Pain Elicited After Pressure Removal From The RIF 📍3. Rovsing's Sign ➡️ Pain Elicited After Abdominal Palpation From LIF To RIF (Pushing Bowel Loops Toward The Inflamed Appendix) 📍4. Psoas Sign ➡️ Pain Elicited After Right Hip Extension 📍5. Obturator Sign ➡️ Pain Elicited By Hip Flexion & Internal Rotation 📍6. Pointing Sign ➡️ Patient Pointing Where The Pain Started & Moved 📍7. Dunphy Sign ➡️ Pain Elicited By Cough 📍8. McBurney's Sign ➡️ Severe Pain Elicited By Finger Tip Pressure Over McBurney's Area (Between Umbilicus & Anterior Superior Iliac Spine)

🔶C. Alvarado (Mantrels) Score (≥7 Points Strongly Suggest Appendicitis)

▪︎RIF Tenderness/Leukocytosis ➡️ 2 Points For Each ▪︎Migratory (Shifting) Pain/Anorexia/Nausea & Vomiting/Elevated Temperature/Rebound Tenderness/WBCS Shifting To Left (Immature Segmented Neutrophils Production) ➡️ 1 Point For Each

🔶D. Lab & Imaging

1. US ▪︎Lumen Dilatation >3mm ▪︎Wall Thickness >6mm 2. Contrast CT Of Abdomen (Best) 3. CBC ➡️ Leukocytosis 4. Pregnancy Test To Exclude Ectopic 5. Urinalysis To Exclude UTI & Stones

🔶E. Atypical Features

1. RetroCaecal Appendix ➡️ No Rigidity/Psoas Spasm & Hip Flexion Develop 2. Pelvic Appendix ➡️ Diarehea/Increase Urine Frequency/No Rigidity/Rectal Examination Elicits Tenderness 3. Postileal Appendix ➡️ Retching & Diarrhea/No Pain Shifting/Mild Tenderness https://t.me/Clinicalsurgeryround

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إن شاء الله تعالى سوف يتم نشر موضوعين كل يوم من القائمة التالية بالرغم من نشر بعض هذا المواضيع من قبل ولكن مع الايام القادمة بإذن الله سوف نكمل كل ال Topics

🔰Sections 📌 Surgery Content 📌

A. General Surgery

🔰Most Common Topics in Surgery

1. Appendicitis 2. Abdominal Hernia 3. Gallstones & Cholecystitis 4. Pancreatitis 5. Thyroid Enlargement (Goitre) 6. Bowel Obstruction 7. GIT Bleeding 8. Jaundice

🔰GIT Surgery

1. Esophagus ▪︎Achalasia & Diffuse Esophageal Spasm ▪︎GERD ▪︎Hiatus Hernia ▪︎Esophageal Diverticulae (Pouches) ▪︎Esophageal Perforation 2. Stomach & Duodenum ▪︎Peptic Ulcer Disease 3. Liver & Biliary Diseases & Infections ▪︎Hydatid Liver Disease ▪︎Amoebic Liver Abscess ▪︎Pyogenic Liver Abscess ▪︎Ascending Cholangitis ▪︎Portal HT & Variceal Bleeding 4. Small & Large Bowel ▪︎Colonic Diverticulae ▪︎Small Bowel Diverticulae ▪︎Angiodysplasia ▪︎Mesenteric Ischaemia ▪︎Ulcerative Colitis ▪︎Crohn's Disease 5. Bowel Infections ▪︎Ascariasis (Round Worm Infection) ▪︎Typhoid (Enteric) Fever 6. Anal Canal & Rectum ▪︎Haemorrhoids (Piles) ▪︎Anal Fissures ▪︎Anal Fistula ▪︎Pilonidal Sinus ▪︎Ano-Rectal Abscess ▪︎Rectal Prolapse

🔰Common Tumors in Surgery

1. Colo-Rectal Cancer 2. Intestinal Polyps 3. Gastric Cancer 4. Esophageal Cancer 5. Pancreatic Cancer 6. Liver Tumors 7. Biliary Tumors 8. Thyroid Malignancy

🔰Breast Diseases

1. Breast Cancer 2. Benign Breast Conditions (ANDI) ▪︎FibroAdenoma ▪︎Mastalgia ▪︎Breast Cysts & GalactoCele & Duct Ectasia 3. Benign Breast Tumors ▪︎Phyllodes & Papilloma & Lipoma 4. Breast Infections & Inflammation ▪︎Lactational Mastitis ▪︎Non-Lactional Mastitis & Mondor’s Disease

🔰Remaining Topics

1. Shock & Haemorrhage 2. Peritonitis 3. Salivary Gland Disorders ▪︎Cysts ▪︎Stones ▪︎Tumours 3. Wound Complications ▪︎Wound Infection (SSI) ▪︎Chronic Wound (Ulcers) ▪︎Scars & Contractures ▪︎Compartment Syndrome

🔴Hiatus Hernia

▪︎Abnormal Protrusion Of The Abdominal Organs Through The Esophageal Diaphragmatic Opening into The Thoracic Cavity ▪︎Due To Muscular Weakness Around The Esophageal Diaphragmatic Opening

🔹Risk Factors For Hiatus Hernia

1. Middle Age & Elderly 2. Female 3. Obesity 4. Previous Surgery Near The Diaphragm

🔹Types Of Hiatus Hernia

📍1. Sliding (85-95%) ▪︎Protrusion Of Gastroesophageal Junction (Cardia) Into The Chest & Loss Its Competence (GEJ Herniation Upwards) 📍2. Rolling (ParaEsophageal/True) ▪︎Protrusion Of The Greater Curvature Of The Stomach Into The Chest (Asymmetric Herniation Of The Stomach Next To The Esophagus) ▪︎The Gastroesophageal Junction (Cardia) Remains in its Normal Position 📍3. Mixed (Rolling & Sliding At The Same Time) 📍4. Type IV ➡️ Herniation Of Abdominal Organs Other Than The Stomach into The Chest أي عضو عدى المعدة

🔹Clinical Features Of Hiatus Hernia

📍1. Mostly Asymptomatic 📍2. More With Sliding Hernia ▪︎GERD Symptoms (Heartburn & Regurgitation) 📍3. More With Rolling Hernia ▪︎Pressure Symptoms Due To Gastric Distension (Dysphagia & OdynoPhagia & Chest Pain) That Relieve By Belching ▪︎Palpitation & Hiccups (Due To Pericardial & Diaphragmatic Irritation) 📍4. Gastric Volvulus ▪︎Twisting & Strangulation Then Gangrene & Perforation Of The Herniated Stomach ▪︎More in Large Rolling (ParaEsophageal) Hernia ▪︎High Mortality Rate 📍5. Anemia (Due To Chronic Ulceration & Bleeding)

🔹Dx Of Hiatus Hernia

📍1. Chest Xray ➡️ Gas Bubbles & Fluid Levels in The Chest (Behind The Heart) 📍2. CT With Contrast (Gold Standard Specially in Acute Cases) 📍3. Upper Endoscopy 📍4. Barium Swallow ➡️ Identify The Type & Extent Of The Hernia

🔹Mx Of Hiatus Hernia

📍A. Asymptomatic ➡️ Only GERD Mx 📍B. Emergent Gastric Volvulus 1. Gastric Decompression By NG Tube Or Endoscopy 2. Emergent Hernia Reduction & Defect Repair https://t.me/Clinicalsurgeryround #Hiatus_Hernia@Clinicalsurgeryround

بوت ضخم لجميع محاضرات الجراحة من مرجع Bailey and love مع الجداول

How normal people see it VS. How medical students see it🫀🌟

ملخص يسهل عليك مراجعة ال Hydatid Cyst خلال وقت قصير جداً

🔴Hydatid Liver Disease

▪︎Liver Infection Caused By The Tapeworm (Echinococcus Granulosus Or Multinodularis) That Lives in Dog's Bowel Then Pass To (Cattle & Sheep & Goats & Camels) Then Ingested By The Humans To Pass Through The Portal Blood To The Liver ▪︎Results in Slow Growing Liver Cyst (Infection From Childhood Then Symptoms At Adulthood) ▪︎Common in Middle East (Specially Near Farms مناطق ريفية ومزارعين) ▪︎Liver Most Commonly Involved (Mostly Invade The Right Lobe Of The Liver) ▪︎Lung 2nd Most commonly involved (Mostly Invade Lower Right Lobes) ▪︎Can Invade Any Other Organs (Brain/Pancreas/Adrenals)

🔹Cyst Structure

📍1. Pericyst (Adventitia) ➡️ The Outer Wall Of The Cyst That Formed Due To Inflammatory Reaction To The Parasite 📍2. Laminated Membrane (Ectocyst) ➡️ The Middle Layer Of The Cyst 📍3. Inner Germinal Layer (EndoCyst) ➡️ The Internal Layer Of The Cyst That Contains Viable Parasites & Gives The Daughter Cysts Or Brood Capsule (That Gives ProtoScolices)

🔹Cyst Classification

📍1. Active Group ➡️ Cyst >2cm & Fertile 📍2. Transition Group ➡️ Cyst Start To Degenerate Due To Tx Or Host Immunity 📍3. Inactive Group ➡️ Degenerated & Partially Or Totally Calcified Cyst

🔹Clinical Features & Complications

1. Asymptomatic 2. Chronic Dull RUQ Pain (Due To Stretching Of Liver Capsule) 3. Gradually Enlarging Painful Mass in RUQ 4. Severe Abdominal Pain & Peritonitis After Minor Trauma (Due To Cyst Rupture) 5. Anaphylactic Shock (Due To Cyst Rupture) 6. Obstructive Jaundice Or Acute Cholangitis (Due To Cyst Communication Or Rupture into The Biliary Tree) 7. Liver Abscess

8. Pulmonary Symptoms

▪︎Dyspnea ▪︎Coughing White Material ▪︎Chest Pain ▪︎Haemoptysis ▪︎Fever ▪︎Pleural Effusion ▪︎Empyema (Pus in Pleural Cavity)

9. CNS Symptoms ▪︎Unexplained Headache Or Features Of Raised ICP

🔹Dx Of Hydatid

📍1. Clinical Features 📍2. CBC ➡️ Eosinophilia 📍3. Serology (ELISA & Complement Fixation) ➡️ +Ve in 70-90% 📍4. Chest Xray ➡️ Large Thin Walled Cavity Containing Floating Membrane (Water Lily's Sign) 📍5. US ➡️ Multi-Loculated Cyst 📍6. CT (Best) ➡️ Floating Membrane Within The Cyst (Water Lily's Sign)

🔹Mx Of Hydatid

🔶A. Start First Medical Tx 📍1. Albendazole (400mg 2x Daily For 3m) 📍2. Mebendazole 📍3. Praziquantel (20mg/Kg 2x Daily For 14 Days)

🔶B. Then Do Surgical Tx

📍1. Percutaneous Tx (PAIR) ➡️ Done Only If There's No Communication With Biliary Tree ▪︎Cyst Puncture ▪︎Then Content Aspiration ▪︎Then HyperTonic Saline Installation ▪︎Then ReAbsorption 📍2. Liver Lobe Resection (SegmentEctomy) 📍3. Local Cyst Excision (PeriCyctEctomy) With Omentoplasty 📍4. Cyst Deroofing & Evacuation Of The Content. https://t.me/Clinicalsurgeryround

محاضرة الدكتور نوفل الشميري اليوم #Neurosurgery

رابط قناة الجراحة https://t.me/Clinicalsurgeryround رابط قناة الاطفال https://t.me/Clinicalpediatricround رابط قناة العيون https://t.me/Clinicalophthalomlogy رابط قناة الأشعة https://t.me/Radiologymodules الباطنة https://t.me/Clinicalinternalmedicine

هذه محاضرات من Bailey، لكن مرتبة ومنظمة بواسطة الذكاء الاصطناعي، والاختصار قليل جدًا.