Important knowledge

⚡️Tension hematoma( post thyriodectomy) ▪︎due to bleeding in closed space ▪︎المريض فجاة ورة العمليه يختنك ويصير وجهه ازرك وعندة swelling بال neck Mx ▪︎open the surgical wound , skin & muscle بالردهه حتى اذا ملابس جفوف محد يلومك Then transferring him to theater to stop bleeding ▪︎if still S.O.B ?>>> indotrachal intubation ▪︎if still S.OB ?>> trachiostomy

⚡️Rate of infection in perforated DU is 20 -30% with proper antibiotic

⚡️malignant mass is painless until invade nerve or bone

Paul-Mikulicz stoma ------------------- تختلف عن ال double barrel انه ال ال 2 lobes تنفتح وحدة بصف الثانية وال posterior wall مربوط وحدة بالثانية اما بال double barrel فينفتحن منفصلات وحدة عن اللخ وبيناتهن skin

⚡️Causes of Pseudointestinal obstruction ( Intestinal obstruction with diarrhea) ---------------- ▪︎Richter’s hernia (تعبر فقط fluid وتسوي diarrhea) ▪︎ gallstone ileus (تعبر فقط fluid وتسوي diarrhea) ▪︎mesenteric vascular occlusion ▪︎ functional obstruction associated with pelvic abscess (يسوي irritation لل rectum ) ▪︎ all cases of partial obstruction (تعبر فقط fluid وتسوي diarrhea)

⚡️Tenderness in intestinal obstruction is Alarm feature and it indicate surgery

▪︎Acute intestinal ischaemia = Acute abdominal pain +- blood in stool ▪︎Chronic intestinal ischaemia = chronic severe central abdominal pain after eating (mesenteric angina)

▪︎Amyand's hernia = inguinal hernia contain appendix ▪︎Littre’s hernia = inguinal hernia contain Meckel’s diverticulum

Water lily sign Ruptured hydated cyst

⚡️Dead hydated cyst: ▪︎infected ▪︎calcified ▪︎have bile

⚡️the diameter of hydated cyst is increase about 1cm per year 5cm hydated cyst in liver mean it's age about 5-6 Y

⚡️Carotid sinus hypersensitivity ▪︎bradycardia ▪︎hypotension ▪︎recurrent syncopal attack

⚡️preferred time for cholecystectomy -------------------- ▪︎ it is better done during first 72h or delayed after 4w of acute cholysistitis ▪︎it not a rol and can be done any time but increase risk of complications

⚡️ Biliary dyskinesia (motility disorder) is mimic cholysistitis ▪︎Cholecystokinin (CCK) ⬇️20% ▪︎about 50% only benefits from cholecystectomy لذلك منوعدهم انو راح يتحسنون

⚡️gallbladder stone vs polyp in US ▪︎Stone have acoustic shadow & mobile & have prop tenderness ( من اخلي جهاز ال US على بطنه يصير الم ) ▪︎Polyp no acoustic shadow & no prop tenderness

⚡️lipase may be decrease in very severe pancreatitis (due to cell destruction)

⚡️more than 10 times increase in liver function tests suggest fulminant hepatitis

Red flags for abdominal pain

For any breast lump we use tripple assessment

⚡️وحدة عدها breast lump وكالتلك سويت خزعه شلون تعرف نوعها ؟ ▪︎FNA = متلكة اي اثر ▪︎Tru Cut biopsy = تلكة echemosis ▪︎incisional / excisional biopsy = تلكة scar