خامسة طب بشري / ليبيا

Aortofemoral bypass surgery ◼️A Dacron bifurcated graft is used to overcome an obstruction at the aortoiliac segment by diversion of blood flow from the aorta above the obstruction to the common femoral arteries below the obstruction using a polyester tube (Dacron graft). ◼️The aorta is approached via a midline or transverse abdominal incision, the bowel are retracted to the right side, the posterior parietal peritoneum is then opened to reach the aorta, which is clamped, the patient should recieve 5000 units of heparin. ◼️A vertical incision is made in the anterior wall of the aorta, and the upper limb of the dacron is anastomosed end to side to the aorta see fig ◼️The common femoral arteries are approached via vertical groin incisions and the distal limbs of the dacron are fed to the groins where they are anastomosed to the common femoral arteries again as end to side fashion ◼️The posterior parietal peritoneum should be closed over the dacron to prevent adhesions of dacron to bowel #Vascular_Surgery

Announcement For easy accessibility to different surgical topics on the channel, we have activated the hashtag, all what you have to do is to click on the desired chapter and topics about it will appear, enjoy reading 🌹 #Vascular_Surgery #Breast #Colorectal_Surgery #Abdominal_Surgery #Trauma #Fluids #Hepatobiliary #Endocrine #Thoracic_Surgery #Orthopedics #Urology #Peritoneum #Vermiform_appendix #Spleen #Esophagus #Pediatric_Surgery #Shock #Salivary_Glands #Pancreas #Hernia #Neurosurgery #Surgical_Skills #Embryology We are still in the process of giving hashtags to all the posts, additional chapters will be added in the following few days, this post will be pinned all the time.

End to end bowel anastomosis technique. N.B: Seromuscular suture or Lembert suture, inverts the edges of the cutend of the bowel inwards, thus reducing risk of contamination. #Surgical_Skills

Q:Provide Differential diagnoses? #Neurosurgery

Pre-operative management of pheochromocytoma ◼️Surgical intervention without Preoperative preparation leads to severe hypotension and shock during surgery, this is because patients with pheochromocytoma have blunted vascular sympathetic vasopressor response due to downregulation of adrenergic receptors secondary to chronic stimulation, additionally their plasma volume is low due to continued vasoconstriction. ◼️For this reason patients with pheochromocytoma must be adequately prepared, the drug of choice is PHENOXYBENZAMINE, which is a non-competitve long acting alpha blocker, by blocking alpha receptors it will control the blood pressure and prevent paroxysmal attacks, also it will restore the depleted plasma volume prior to surgery. ◼️The goal is to achieve the optimal dose, start by 10 mg of phenoxybenzamine every 12 hours, and then add 10-20 mg every day until the blood pressure is normalized and paroxysmal attacks disappear. ◼️During phenoxybenzamine therapy a close monitoring of supine and standing blood pressure is mandatory, try to balance your dose as much as possible based on blood pressure readings. ◼️The patient should be on treatment atleast 10-14 days before the operation and encourage liberal salt intake, this time is needed to restore the contracted plasma volume. ◼️Beta blockers should NOT be started before adequate alpha blockade, this is because beta receptors in muscular arteries are responsible for vasodilatation, thus beta blockade leads to loss of this vasodilating effect causing a paradoxic increase in blood pressure. ◼️Beta blockers are still needed only after adequate alpha blockade, this is to control tachycardia and possible catecholamines induced cardiac arrhythmias, the usual drug is propranolol 10 mg every 8 hours, dose can be adjusted to control tachycardia. ◼️Occasional paroxysmal attacks can be controlled "on the spot" by oral prazosin or intravenous phenolamine. #Endocrine

Heart rate and blood pressure in trauma patients ◼️Tachycardia is probably the earliest sign of ongoing hemorrhage and results from increased sympathetic outflow as a compensatory mechanism. ◼️Tachycardia however is not always a reflection of the underlying hemorrhage, for example those patients whose resting heart rate is in the 50s, may develop a heart rate in the 90s when bleeding, this is still below the standard definition of tachycardia but is Clinically signficant and is known as relative tachycardia. ◼️Other variants may alter heart rate, for example patients on beta blockers may not be capable of raising their heart rate, or conversely patients taking cocaine or amphetamine may have tachycardia unrelated to bleeding, additionally pain and hypoxia can cause tachycardia. ◼️Conversely, severe rapid bleeding can cause paradoxical bradycardia, this is an omnious sign and indicate impending cardiac arrest, (for furthur informations on paradoxical bradycardia you can search it on our channel in the search box above). ◼️Blood pressure is an unreliable measure for early hypovolemia, the compensatory mechanisms against shock are able to maintain a normal blood pressure until more than 1500 mL of blood has been lost (about 30% of blood volume), moreover, young fit patients are able to maintain their blood pressure despite severe intravascular deficit due to their strong sympathetic tone until they are on the verge of cardiac arrest. #Trauma

📌 Aspirin is contraindicated in thyroid storm . WHY ? Answer : aspirin displaces thyroid hormones from their albumin binding site increasing their free levels.

Surprisingly skull #Base fractures are more common that those of the #Vault 💡 and that's due to the fact that the base is less elastic and is weakened by the presence of multiple foraminae .

"والنّّفسُ تَرجُو خَلاصًا من مساوِيهَا ‏والرُّوح ، مَا للرُّوحِ غيرُ اللّٰـهِ يُنجِيها

Teach me Davidson ( discussion group ) https://t.me/teachmedavidsondiscussion

قروب ميديسن للاستفادة ( غير خاص بالدفعة )

قروب ميديسن للاستفادة ( غير خاص بالدفعة )

https://t.me/joinchat/3AZmiS7jiNRjZjU0

Ogilvie syndrome . is the acute dilatation of the colon in the absence of any mechanical obstruction in severely ill patients. This is a CT-Scan showing a coronal section of the abdomen of an elderly woman with Ogilvie syndrome . Acute colonic pseudo-obstruction is characterized by massive dilatation of the cecum (diameter > 10 cm) and right colon on abdominal X-ray. It is a type of megacolon, sometimes referred to as "acute megacolon" to distinguish it from toxic megacolon.

Very important note . DCIS is a precursor of malignancy meaning that after certain time in the same place , a breast cancer will develop. While LCIS is a marker of increased risk for developing breast cancer rather than an atomic precursor and that cancer is 65% Ductal !

Allen Oldfather Whipple  (September 2, 1881 – April 6, 1963) was an American surgeon who is known for the pancreatic cancer operation which bears his name (the Whipple procedure ) as well as Whipple's triad. He supervised the surgical residency of Virginia Apgar, later advising her to pursue her medical career in the field of anaesthesiology . Though he is not related to George Hoyt Whipple — who named Whipple's disease and discovered Tropheryma whipplei — the two were lifelong friends.

Important Note : Male breast cancer is preceded by gynaecomastia in 20 % of cases But gynaecomastia is not a risk factor for male Breast cancer 💡 Bailey , sabistian , shwartz.