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📌Important Note: Double duct sign on MRCP: dilation of CBD and pancreatic duct on imaging is very suspicious of underlying malignancy (pancreatic or periampullary tumor)

Most common intra-abdominal organ affected in traumatic injuries is the spleen. The 2nd most common organ is the liver. #surgery

🌟جدول جميل من جات عن اسماء العمليات المشهورة وكل organ او indication تابع الها اشرتلكم المهمات

A 22-year-old man is brought to the emergency department after a motorcycle accident. He complains of severe left upper quadrant pain and left shoulder pain. On examination, BP is 110/70 mmHg, pulse is 105/min, and he responds well to IV fluids. FAST scan shows free intraperitoneal fluid. Contrast-enhanced CT reveals: Splenic laceration measuring 6 cm deep Intraparenchymal hematoma measuring 4 cm No contrast blush Moderate hemoperitoneum What is the most appropriate management?

Always start with the simplest, most available, cheap, radiation free imaging modality.

A 28-year-old man is brought to the emergency department after a high-speed motor vehicle collision. He is hemodynamically stable after initial resuscitation. Contrast-enhanced CT scan reveals a liver laceration involving approximately 50% of the right hepatic lobe (segments V, VI, and VII). There is active contrast extravasation extending beyond the liver parenchyma into the peritoneal cavity. Which of the following best classifies this injury according to the AAST liver injury grading system?

‼️Cystic dilation of CBD occurs in ==> type-1 biliary atresia ‼️Most common form of anorectal malformation (ARM) in male is recto-urethral fistula ‼️Most common form of ARM in female is recto-vestibular fistula ‼️diagnosis of hypertropic pyloric stenosis is confirmed with US ‼️Soap bubble appearance on X-ray + NO air-fluid level ==> uncomplicated meconium ileus. ‼️Most common type of tracheoesophageal atresia (TEA) is type C TEA (atresia with tracheoesophageal fistula in distal pouch) #surgery_ped

A 2 days old Neonate presents with bilious vomiting ==> think jejunal atresia أسالة السنين #surgery_ped

📌 اهم الملاحظات والاشياء الي ركز عليها Dr. Muayyad بمحاضره الـBiliary 🔹 Patients with DM and asymptomatic gallstones may require prophylactic cholecystectomy because of the higher risk of complications. 🔹 Patients planned for bariatric surgery who have gallstones should undergo cholecystectomy before/with bariatric surgery. 🔹 Immunocompromised patients may need prophylactic cholecystectomy. 🔹 Brown pigment stones are commonly found in the bile duct (CBD). ━━━━━━━━━━━━━━ 📍 Case 1 A patient underwent cholecystectomy and later developed: • Yellow discoloration of the eyes • Tea-colored urine • Itching Management: LFT → ALP ↑ → Direct bilirubin ↑ Ultrasound → Check for biliary dilatation MRCP → Assess obstruction or bile leak ERCP → Diagnostic and therapeutic ━━━━━━━━━━━━━━ 📍 Case 2 Patient developed obstructive jaundice after cholecystectomy. ERCP showed a biliary stricture with no retained stone. Management: A. ERCP + stent insertion B. If the stricture is high: → Percutaneous Transhepatic Cholangiography (PTC) ━━━━━━━━━━━━━━ 📍 Case 3 Patient is 2 days post-cholecystectomy and presents with: • Fever • Pain at operative site Investigations: Ultrasound → Collection in right hypochondrium Blood tests → Leukocytosis Diagnosis: Biloma → may become infected and form an abscess. Management: • Drainage of the collection • ERCP with stent if bile leak is present • Continue drainage until output becomes clear ━━━━━━━━━━━━━━ 📍 Case 4 70-year-old patient presents with: • Obstructive jaundice • Palpable gallbladder • Weight loss • Yellow sclera ⚠️ Malignancy until proven otherwise. Q: Why is the gallbladder palpable in malignant obstruction but usually not palpable in stone obstruction? Answer: Malignant obstruction develops gradually, causing progressive distension of the gallbladder with bile, making it enlarged and palpable. In gallstone disease, repeated attacks of cholecystitis cause fibrosis and shrinkage of the gallbladder, preventing distension even when obstruction occurs. (Courvoisier’s Law) ━━━━━━━━━━━━━━ • Brown stones → Common in bile ducts. • Palpable gallbladder + painless obstructive jaundice → Think malignancy. • Proximal bile duct tumors → Worse prognosis. • Distal bile duct tumors → Better prognosis.

📌اهم الملاحظات والاشياء الي ركز عليها دكتور مؤيد بمحاضرة الـBiliary system -Patient with DM and have gall stone but without symptoms require prophylactic Cholecystectomy why? Because of high risk to develop complications - patient want to do bariatric surgery so when there is gallstone we must do Cholecystectomy before bariatric surgery - patient with immune deficiency need prophylactic cholecystectomy - Brown stone found in Bile duct commonly Case-1- سويت عملية رفع مرارة لمريض وراها رجع للدكتور كال اله صار عندي Yellowish discolouration in eye و tea colour urine وصار عندي itching شنو الsteps مال management لهذا المريض؟ 1- Send him for LFT We will see the ALP elevated and Direct bilirubin Elevated 2- we send Ultrasound to check for dilation 3-then MRCP to see if there is dilation due to obstruction or there is leak 4- then ERCP Case-2- patient come with obstructive jundiance after surgery of cholecystectomy you send him to ERCP and see there was stricture but no stone on the location of surgery What are the steps of management? 1- we have to option A-ERCP with stent to over come obstruction B- If stricture was high up. We do percautenous transhepatic cholangiography Case-3- Patient on drain after cholecystectomy procedure done last two days , come with heat and pain in the site of surgery what are steps of management? 1- i send him for US we se there is collection of in RT hypochondriac area 2- blood investigation shows (leucocytosis ) 3-then means patient have Biloma → may become infected and form abscess 4- Managed by placing drain until the drain fluid becomes clear I will do ERCP with stent Case -4- patient 70 years old come with palpable gallbladder and obstructive jundiance, weight loss and yellowish discoloration of scelera (This patient regarded as malignant until proven otherwise ) Q: Why is the gallbladder palpable in malignant biliary obstruction but usually not palpable in stone obstruction? Answer: In malignant obstruction (e. the obstruction develops gradually, causing progressive distension of the gallbladder with bile, so it becomes enlarged and palpable. In contrast, patients with gallstones usually have repeated episodes of cholecystitis leading to chronic inflammation, fibrosis, and contraction (shrinkage) of the gallbladder. Therefore, even if the common bile duct becomes obstructed by a stone, the gallbladder cannot distend and is usually not palpable. - proximal tumours of bile duct have bad prognosis For -distal tumours of bile duct have good prognosis #GeneralSurgery_L10