أسئلة paper 1 فبراير 2024 ⬆️

حَسْبِيَ اللَّهُ لَا إِلَهَ إِلَّا هُوَ، عَلَيْهِ تَوَكَّلْتُ
وَهُوَ رَبُّ الْعَرْشِ الْعَظِيمِ.

من قالها حين يصبح وحين يمسي ٧مرات
كفاه الله ما أهمه من أمر الدنيا والآخرة.💙

#Biliary system ⬇️ ♻️

Gall stone diseases✨

🔹 Biliary System :
      CHD : 4mm approximately
      CBD : 6-8 mm  approximately
      Cystic duct : 4 mm approximately
      GB   : 7-10 mm approximately

Key points ⬆️
#Biliary

عرفتوا Dx ؟ 🫡🔥

❤ Yes
💔 No

#Dx is Ascending cholangitis 🥳🎊
(Charcot's triad).

📚Biliary tract Lesions:🚨

🎴Pain = Cholelithiasis
🎴Pain + Pyrexia = Acute Cholecystitis
🎴Pain + Jaundice = Choledocholithiasis
🎴Pain + Pyrexia + Jaundice (Charcot's triad) = Ascending Cholangitis.🍁

⭕️The 4 features of obstructive jaundice :😉
1. Dark urine.
2. Pale stool.
3. Jaundice.
4. Itching.

Gallbladder ✅


Blood supply from Rt hepatic AR-->cystic artery .

Venus drange from cystic vein to--->
Rt portal vein

Nerve supply from Lt vagus N--> Ant gastric N --> cystic nerve .

Lymphatic drange: Lund --> portal hepatic LN ---> celiac LN.

Calot's triangle.

Type of stones

Mirizzi's syndrome

🚫In acute cholecystitis if there is no jaundice there is no need for MRCP/ERCP, ✔️✔️✔️

Dx of Acc  ➡️cbc /US if us inconclusive  use HIDA SCan
For exculde jaundice Act ➡️LFT.

🛑 Murphy's sign : positive If pt suddenly stop inspiration while you are palpating on the site of Gallbladder.

🛑Murphy's sign specific for acute cholecytitis.

⭕️ Complications of acute cholecystitis :

¹ empyema
² emphesematose
³ Obs jaundice
⁴ fistula
⁵ abscess
⁶ perforation

Note : No small intestinal obstruction complications in acute cholecystitis.