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Q/ A 35-year-old man presents with right upper quadrant pain, fever,
jaundice, and shaking chills. Ultrasound of the abdomen demonstrates
gallstones, normal gallbladder wall thickness, and common bile duct of
1.0 cm. His total bilirubin is 5. In addition to IV fluids and antibiotics,
which of the following is the most appropriate next step in this patient’s
management?
Q/ 30 y old lady presented with H/o  of acute pain in right hypochondrium which is radiating to angle of the right scapula she vomited few times as well the D/D diagnosis of the lady 's symptoms includes all of the followings Except:
60 years old lady following total pancreatectomy she has started complaining of foul smelling stool which is difficult to flush lacking which enzyme you think is responsible:
Anonymous Quiz
11%
CCK
77%
Lipase
6%
Amylase
3%
Trypsine
3%
Secretin
Choose the correct IX which can be used to Dx and R of CBD STONES :
Anonymous Quiz
7%
MRCP
83%
ERCP
5%
U/S
5%
HIDA scan
Appendicitis 🚼

💥 Age ——> 5 to 15 y

💥 Site ——> ¹ retrocaecal 60%
                      ² pelvic 35%

💥 Pathogenesis ——> obstruction of lumen = hypertrophoid lymphoid or tumor or facolith

Symp ——>

تعطيه أمه طرف 🍫 يقول لا مانبيش = anoroxia
بعدها يقعد يعيط اه بطني اه بطني 🎻 = pain
بعدها  = vomiting

ايطيرو بيه اهله ونستلموه 😈🤦‍♀

أول شي نديره نشوف vital signs نلقى الحرارة زايدة درجة بس ماتفوتش 38.5 والبلس طبيعي
بعدها نرقده ع 🛏 ونفحص بطنه
Special test

¹ Rebound tenderness
² rovsing sign
³ psoas sign
⁴ obturator signs

ونبعت تحاليل تبع d.d of right iliac fossa pain
بعد درت التحاليل وUS وجمعت معلوماتي 😁 جي وقت الورقة والبيرو ونحسب

لو لقيت عنده 3 اعراض  تبع 🍫 وأخوانها نعطيه 3 درجات 😌👍

ولو لقيت عنده RIF tenderness ياخد درجتين

ولو لقيت عنده Rebound tenderness  ودرجة الحرارة مرتفعة شوية ياخد درجة ع كل وحده

ولما نشوف تحاليل لو لقيت WBC مرتفعة هنا يستاهل درجتين 🤣

طبعا يلي ندير فيه هوا كله اسمه
Alvarado scores
نجمع ونقسم ونطرح
لو لقيته محصل فوق من 7 معناها ناجح 😍 هديته appendectomy

ولو لقيته اقل من 4 يروح..

ولو لقيته محصل 5 او 6 هنا ضروري نتأكد
لهذا نديروله تحقيق بي Ct scan او Us باش نعرفوا هل انحوها الزايدة او تقعد

ولو مادرتش appendectomy حتصيرله مشاكل
اللي هما
Complications of appendicitis :

¹ appendicular mass

نعالجها بي oschner sheren Regim
وبعد 3 شهور appendectomy

² Generalized peritonitis

Ttt = resuscitation and laparotomy

³ appendicular abscess

Ttt = drainage then sherin regim the surgery after 3 months.
صباح الخير جميعاً.. أسئلة اليوم حتكون على I.O إن شاء الله.🙋‍♀

🔻 Triad of small bowel obstruction in plain X-ray :
1. Dilated small bowel loops > 3 cm
2. Multiple air fluid levels in erect X-ray
3. Paucity of air in the colon

🔻 Complications of intestinal obstruction:
  •Peritonitis
•  Hypovolaemic and septic shock  .
•Renal failure .
•  ARDS.
•Intra-abdominal. abscess formation.
•Moribund status.
Forwarded from Internal Medicine By Doha (Doha Ali Rawaq)
⚀Description
Erect abdominal x ray
AP view
Showing multiple air fluid level

⚀Most likely DX
IO (Intestinal obstruction )

⚀Next step
➡️Medical TTT
NPO
IV fluids
Analgesics
Antibiotics

➡️Surgical TTT
Resection and Anastomosis

https://www.tg-me.com/internal_medicine_Dr_Doha💮

لا تنسونا من صالح الدُعاء.🤲🌟🌙🧡
2024/09/28 01:23:35
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