Important knowledge

⚡️History of trauma ( checklist علي عادل ) ------------- مهم OSCE ----------- ♦️penetrating injury ( stab wound , pullet injury) 1) C.C > Penetrating wound لتكول stap wound او pullet او gunshot 2) type of penetrating injury ♧ pullet ♧ stab wound 3) ▪︎ if stap wound : ♧Type of Knife ♧ direction of injury ♧ number of stabs ♧ input & output? ( rare) ▪︎If pullet injury ♧ type of firearm ( low velocity vs high velocity) ♧ distance ♧direction ♧ number of pullet ♧ input & output? 4)symptoms ▪︎Bleeding ▪︎pain ▪︎vomiting ▪︎S.O.B (chest or diaphragmatic injury) ▪︎headache ▪︎loss of conscious ( may have head trauma) ▪︎disability ( ميكدر يحرك ايد او رجل ميكدر يمشي) ▪︎other injuries (as head trauma ) 5) first aid measures 6) mode of delivery 7) injury to hospital time 8) measures at hospital ------------ ▪︎causes of decrease level of conscious after trauma? ♧ shock ♧ head injury ♧ alcoholic ♧ hypoglycemia

⚡️Smoking & hernia ------------------- ▪︎patient should wait at least 8 W (2M) after stop smoking to do surgery (up to 6 M) ▪︎smoking is contraindicated for hernial repair for 2 causes : ♧ impair wound healing ♧ ⬆️Intra-abdomal pressure (cough) >> recurrence

⚡️Any hernia should be operated after diagnosis except 2 types ------------------------ ▪︎direct inguinal hernia in elderly (wait & see) ▪︎umbilical hernia in infants (wait till 2-4 Y mostly resolved ) [ but there is indications for surgery]

⚡️Negative bowel sound in hernial Bulging mean: ▪︎omentum ▪︎paralyzed bowel ( due to late I. Obstruction)

⚡️pain assotiated with rectal bleeding & causes علي عادل ------------------------- ▪︎anal pain = fissure & incarcerated hemorrhoids ▪︎dysuria = Anterior progression of malignancy ( to bladder) ▪︎ back pain = Posterior progression of malignancy ( to sacral plexus) ▪︎colicky abdominal pain = due to intestinal obstruction (by tumor)

⚡️Other areas for bowel sound auscultation? ▪︎hepatic flexure ▪︎splenic flexure ▪︎left mcburnry's point

⚡️Why mcburney's point is the best for bowel sound auscultation? علي عادل ▪︎fixed cecum ▪︎illocecul valve ▪︎narrow ileum open in wide cecum

⚡️examination of spleen 3 steps د.علي عادل ------------------- ▪︎تفحص من ال RIF وتصعد ، اذا ممحسيتة !؟ >> ▪︎تسوي biannual maneuver تخلي ايدك الثانية جوه ال spleen وتحس ، زين واذا هم محسيته !؟>> ▪︎تكلب المريض على ال right lateral position وهم تفحصة biannual maneuver

د.علي عادل ▪︎acute ischemia = pale & cold ▪︎chronic ischemia = red & hot ( due to reactive hyperemia)

⚡️Most common cause of breast abcess is lactation

⚡️Causes of gluteal abcess post IM injection د. علي عادل ----------------------- ▪︎crystalization of drug material ( مذايبة زين لذلك لازم نخضها زين قبل لانضرب ( ▪︎injection in fatty tissue (especially obese) > most common cause ▪︎infection by contaminated needle ▪︎Immunocompromised

⚡️Posative obturator sign = suprapubic pain ( not RIF)

Classic symptoms of cholangitis (not cholycistitis) is ‘Charcot’s triad ▪︎RUQ pain ▪︎ jaundice ▪︎ fevers If becoming ascending Suppurative cholangitis will develop " Reynold pentad " - the previous 3 symptoms + 2 ▪︎septic shock (late > hypotension) ▪︎altered mental status (⬇️level of conscious) ♧ It is emergency⚠️

⚡️How to differentiate between biliary colic & cholycistitis ?! مهم جدا ---------------------- ▪︎fever in cholysistitis vs no fever in biliary colic (mostly) ▪︎time >6 hours in cholycistitis vs < 6 hours in biliary colic ▪︎CBC : leukocytosis in cholcystitis vs no leukocytosis in biliary colic

Post op. fever

⚡️post op intestinal obstruction ------------------------------ ▪︎patient not pass feces & flatus72h post op. & signs of I.O = Paralytic illius ▪︎patient pass feces & flatus post op. & after some days there is no feces & flatus & signs of I.O = Adhesion

⚡️Causes of Paralytic illius post op. (د.وسام) ------------------------ ▪︎spinal cord injury ▪︎sepsis ▪︎hypokalemia ▪︎uremia

⚡️You should take at least 10 biopsy if you found stomach ulcer & negative biopsy not exclude malignancy