Session-3-Dr.Abdulkareem
o Intermittent fever:- Feverish pt but at specific time
then return to normal
o
Swinging fever:-
constant rise in body temperature above
the normal range .
o
طول الفترة عالية اعلى من النورمال
الليل
,
الظهر
,
الصبح
,
يوصل
04
o
Hectic fever :-
constant increase in temperature , rise & then
decrease.
o
يسخن باليل والصبح بس
*pt with fever has headache always "typical Hx".
o pt with Hx of abscess in inguinal region , we should ask about
GUT as "dysuria,frequency,urgency", musculoskeletal system
o intermittent claudication :why it occurs in pt with abscess ?
because of psoas muscle spasm .
How to know this is arterial or venous claudication?
Pale :arterial.
Congested:venous.
General exam :
Consciousness ,alertness ,comfortable or not ,position ,,lying on bed?,
jaundice?,anemia?,cyanosis?,clubbing?,leg edema?,LAP?.
Jaundice :- yellow discoloration of sclera & mucous membrane.
How to examine?
On day light
Looking down
Mouth
Palmar creases.
If we examine for anemia ? ask pt to look up and u look for
conjunctiva.
Causes of clubbing
Cardiovascular : TOF,TA,TGA.
Respiratory : CF,Bronchogenic CA "small cell carcinoma".
GIT :UC,Crohn's disease,ceiliac disease.
Lymphedema :where do we look for it ? on shin of tibia.
LAP
نفس
ه
درسناه
س
ابقا بسشن
د
-
عماد
Abdominal exam
How to differentiate spleen from other masses?
نفسه فرق الkidney نعspleen دولاكاملا يف
Sites of bowel auscultation?
-lt iliac fossa:iliocecal junction.
-Duodenojejunal junction (2)cm above and lateral
the umbilicus.
-Mcburney's point.
Before finishing abdominal exam , what do u
want to examine?
-DRE.
-back كل خطوات ع
دا
auscultation .ماعدنا
-L.N:-scalene L.N:virchow's sign :troisier
sign.(trousseau sign in leg).
-Gentilia(testes)NOT scrotum .
-Hernial orifices.
Case (Hydatid cyst of the liver )
Organism Echinococcus granulosus.
Hostintermediate host :- human&cattle.
Final host :- dog/wolf.(from its intestine into feces
on the grass).
Why the pain radiate sometimes to Rt shoulder ?
because of the same dermatomal innervation.
What do we call this pain"radiated from another
site"??? it is called referred pain.
Percentage of Hydatid cyst distribution?
Liver 80%.
Lung 15%.
All other body sites 5%(brain,bone,breast).
**Hydatid cyst can affect all body organs except
nails,hair.
Why do we operate on HC?
1.risk of anaphylaxis:because of rupture.
2.pressure symptoms.
3.rupture inside biliary tract .
Can hydatid cyst be transformed into
malignancy ?
No ,except if Echinococcus multiforme was the
causative agent.
Investigation US,CT scan,chest xray.
Rx:-surgical exploration,,prophylaxis after
surgery consists of :
-Tinidazole 100mg
-albendazole 200mg
-mebendazole 400mg.
Types of surgerical procedure
1)inoculation.
2)evacuation with aspiration.
3)excision of the segment or lobe which contains
the cyst.
4)under US guide :aspiration of the cyst content.
Why we give Antibiotics before the surgery?
1-dirty op.
2-infected cyst.
3-dirty theatre.
Notes
Hydatid cyst pt recovery duration is (6)mo so
no US should be done at this time.
Pt had serous"contain bile" to brown
(serosanguinous fluid in his drain bag about
50cc).
Portal vein(4cm) :-superior mesenteric + splenic
veins.
Inferior mesenteric vein drain in splenic vein.
CBD(4cm length)+Optic nerve(4cm
length)+carotid bifurcation(at C4 level)+phrenic
nerve"diaphragm"(C2,C3,C4,C5)+cricothyroid
(at C4)all share number"4".
Quadrate lobe of liver from which G.B
originate.
All drugs has allergy & cross reaction except
azithromycin(macrolids group).
Ceftriaxone has 15-20% cross reaction with
pencillin.
Rutherford Morrison incision for appendicitis
muscle cutting.
Lanz & Grid iron incision cosmetically is the
difference between them only.
Types of wound
:-
Dirty perforated viscus.
Cleaninguinal hernia.
Clean-contaminatedHydatid cyst,appendix.
Contaminatedperforated appendix.
