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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.