Summary surgery 🤍

السلام عليكم قروب c إن شاءالله حنبدو مراجعات وملخصات كل شي يخص روتة الجراحة والمصدر حيكون د. خالد ميلاد

🔺Breast : -Extend-upward to  2rib -Extend downward at 6rib -Medially:lateral border of sternum -Laterally:anterior Axillary line   -Breast rest on : ·   Pectoralis major ·  External oblique muscle(Inferior medially ) ·Serratus anterior muscle (Inferior laterally )   🔺Blood supply to breast : 1. Internal mammary artery 2. Intercostal artery 3. Thoraco acromial artery 4. Lateral thoracic artery 🔺Lymphatic drainage : 1. Axillary lymph node (MC 85%) 2. Internal mammary LN 3.Peritoneal lymphatic plexus in rectus sheath     🔺Congenital breast disease: 1. Athelia 2. Polythelia 3. Amazia 4. PolyMazia 5. Poland syndrome (Amazia and No pectoralis major)     🔺Breast trauma : 1. Fat necrosis (Hard mass ,Painless ,associated with nipple retraction ) 2.Breast haematoma (Hard mass ,painless, associated with nipple retraction) Differentiated from Cancer by biopsy   🔺Acute lactational mastitis · Due to staphylococcus aureus · Milk engorgement · Abrasion to nipple due to suckling ·  Poor hygiene ◽️Sign : ·  Dull aching pain ·  Hotness and redness ·  Higher pyrexia ·  Tenderness Form abscess ➡️Throbbing pain ◽️ttt ➡️Antibiotics /Incisional and drainage of abscess       🔺Duct ectasia(Plasma cell mastitis ): · Abnormal dilation of major duct of breast ·  Nipple discharge: purulent (yellow,brown, green ) ·  Nipple retraction ·  Periductal abscess · Mammary fistula · ttt➡️ Excision and biopsy   🔺Fibrocystic disease of breast (ANDI) (Fibroadenosis)(Mammary dysplasia ) · Most frequent breast disorder ·Multiple,psinful,small lump ,in relation to MC · Nipple discharge (Yellow or clear ) · Mastalgia ·Ttt: Aspiration of cyst /NSAID/antiestrogen /Androgen       ◽️Benign lesion : 1.Intraductal papilloma · Blood nipple discharge ·  Retro areolar mass     2. Fibroadenoma : · Commonest breast mass of young 🚺 · 15-30y · Painless lump · Small · Non tender ·Firm will circumscribe · High mobility within breast (Breast mouse) ·ttt➡️Excision 3.Phylloid’s tumor (Brodie’s sarcoma ) ·Rare condition · Slow grow swelling ·Large in size ·Skin necrosis and ulceration   🔺Risk factor of Breast cancer : 1.Genatic  BRCAI /BRCAII 2.Family history 3.Age 4.Early menarche 5.Late menopause 6. Unmarried 7.Nullipara 8.Non lactating 9.Long use of OCP 10. Exposure to radiation 11. Alcohol consumption 12. Cigarette smoking 13. Obesity 🔺Symptoms and sign of Malignant lesion : · Painless lump ,Nipple retraction with blood discharge,Hard mass fixation to skin · Skin dimpling · Peu d’orang · Skin nodule · Skin ulceration ·Axillary and supraclavicular LN palpable 🔺Investigation: 1.Mammography 2.Ultrasound 3.Biopsy · Fine needle aspiration · True cut biopsy · Frozen section biopsy · Incisional biopsy · Exesional biopsy   🔺Triple assessments: 1.     Clinical examination 2.     Radiological (X-ray ,USS) 3.     Pathological (biopsy)

Oral discusion

مهم في oral discusion كيف ال DD

#General_surgery 1-Breast lump

DDx of painful mass: 1. Fibro adenosis 2. Cyst 3. Perisuctal mastitis 4.Acute abscess DDx of painless mass: 1. Carcinoma 2. Fiboadenoma 3. chronic abscess (Antibioma)

DDx of Mastalgia and tenderness: Relet to MC Non cycle (Acute mastitis)

🔺Breast : -Extend-upward to  2rib -Extend downward at 6rib -Medially:lateral border of sternum -Laterally:anterior Axillary line   -Breast rest on : ·   Pectoralis major ·  External oblique muscle(Inferior medially ) ·Serratus anterior muscle (Inferior laterally )   🔺Blood supply to breast : 1. Internal mammary artery 2. Intercostal artery 3. Thoraco acromial artery 4. Lateral thoracic artery 🔺Lymphatic drainage : 1. Axillary lymph node (MC 85%) 2. Internal mammary LN 3.Peritoneal lymphatic plexus in rectus sheath     🔺Congenital breast disease: 1. Athelia 2. Polythelia 3. Amazia 4. PolyMazia 5. Poland syndrome (Amazia and No pectoralis major)     🔺Breast trauma : 1. Fat necrosis (Hard mass ,Painless ,associated with nipple retraction ) 2.Breast haematoma (Hard mass ,painless, associated with nipple retraction) Differentiated from Cancer by biopsy   🔺Acute lactational mastitis · Due to staphylococcus aureus · Milk engorgement · Abrasion to nipple due to suckling ·  Poor hygiene ◽️Sign : ·  Dull aching pain ·  Hotness and redness ·  Higher pyrexia ·  Tenderness Form abscess ➡️Throbbing pain ◽️ttt ➡️Antibiotics /Incisional and drainage of abscess       🔺Duct ectasia(Plasma cell mastitis ): · Abnormal dilation of major duct of breast ·  Nipple discharge: purulent (yellow,brown, green ) ·  Nipple retraction ·  Periductal abscess · Mammary fistula · ttt➡️ Excision and biopsy   🔺Fibrocystic disease of breast (ANDI) (Fibroadenosis)(Mammary dysplasia ) · Most frequent breast disorder ·Multiple,psinful,small lump ,in relation to MC · Nipple discharge (Yellow or clear ) · Mastalgia ·Ttt: Aspiration of cyst /NSAID/antiestrogen /Androgen       ◽️Benign lesion : 1.Intraductal papilloma · Blood nipple discharge ·  Retro areolar mass     2. Fibroadenoma : · Commonest breast mass of young 🚺 · 15-30y · Painless lump · Small · Non tender ·Firm will circumscribe · High mobility within breast (Breast mouse) ·ttt➡️Excision 3.Phylloid’s tumor (Brodie’s sarcoma ) ·Rare condition · Slow grow swelling ·Large in size ·Skin necrosis and ulceration   🔺Risk factor of Breast cancer : 1.Genatic  BRCAI /BRCAII 2.Family history 3.Age 4.Early menarche 5.Late menopause 6. Unmarried 7.Nullipara 8.Non lactating 9.Long use of OCP 10. Exposure to radiation 11. Alcohol consumption 12. Cigarette smoking 13. Obesity 🔺Symptoms and sign of Malignant lesion : · Painless lump ,Nipple retraction with blood discharge,Hard mass fixation to skin · Skin dimpling · Peu d’orang · Skin nodule · Skin ulceration ·Axillary and supraclavicular LN palpable 🔺Investigation: 1.Mammography 2.Ultrasound 3.Biopsy · Fine needle aspiration · True cut biopsy · Frozen section biopsy · Incisional biopsy · Exesional biopsy   🔺Triple assessments: 1.     Clinical examination 2.     Radiological (X-ray ,USS) 3.     Pathological (biopsy)

هنا للبصمجة عنوان مش شرح معلش ع شان نحلو ال mcqs😂

Ulcer➡️Discontinuity  of epithelium ◽️Causes of Ulcer: 1. Traumatic 2.Infection 3.Neurotrophic 4.Ischemia 5.Venous 6.Neoplastic 7.Haemolytic anemia (SCA ) 8.CTD   1. Venous Ulcer: ·  DVT ·Varicose vein 🔺Clinical picture : · Ulcer around medial malleolus · Slopping edges ·Eczema around ulcer .Brownish pigmentation · Varicose vein 🔺Complication : · Malignancy (Marjolin ulcer) · Periostitis · Deformity   2.Ischemic ulcer :Due to sever chronic ischemia ·  At tip of toes · Deeply stained with Punched out edge · H/O atherosclerosis 3. Neurotrophic ulcer : · In pressure area (Sole ,Heal ) ·  Punched out edge · H/O DM, peripheral neuropathy   4. Neoplastic Ulcer : ·Basal cell carcinoma (Rodent ulcer ) -Prolonged exposure to sun ray -oval or round ulcer ,small in size ,Rolled in edge   · Squamous cell carcinoma: -irregular shape ulcer,Rasie  everted edges     🔺DDx of leg ulcer : ·  Venous 60% ·  Ischemia 20% · Neurotrophic · CTD · Traumatic · Neoplastic

🔺Intestinal obstruction :   1. Dynamic ➡️Peristalsis is working against obstruction 2. A-dynamic ➡️Failure peristaltic waves due to failure of neuromuscular mechanism 🔺Clinical pictures of intestinal obstructions: 1. Vomiting 2. Visible peristalsis 3. Constipation 4. Colic 5. Distention of abdomen 6.Dehydration

🔺Acute pancreatitis: ·Sever epigastric pain referred into back ·Pain decreased by lying forward ·Symptoms (Profuse vomiting ,Shocked ,Tenderness  ,guarding ) ·Cullen’s sign (Bruising around umbilicus) .Grey Turner’s sign (in loin ) ·Raised serum amylase with 12hr

🔺Appendix · Sites: -Retro cecal (MC 70%) -Sub cecal -Pelvic -Preilial ·Arterial supply ➡️Appendicual artery branch from Superior mesenteric artery  ◽️More common in 2nd ,3rd decade ,affect in any age ◽️Usually shifting pain from central to right iliac fossa. ◽️Symptoms: ·Vomiting (Occurs after pain ) · Nausea · Constipation ·Anorexia ·Localized tenderness (present always in RIF ,But not always over MC Burney’s point )   🔺MCBurney’s point ➡️At junction of inner two third and outer one third of line extend from umbilicus to ASIS   ·Rigidity ➡️indicate to perforated appendix 🔺Special signs : 1. Rovasing’s sign ➡️When deep palpation of LT lower quadrant felt pain in RT lower quadrant .   2.Psoas sign ➡️Pain extend to right thigh  ,by psoas spam due to irritation retrocecal appendicitis     3.Obturator sign➡️irritation of obturator internus by pelvic appendicitis 4.Rebound sign (Blumberg’s sign )

🔺Stress Ulcer➡️ cause PU 🔺Cushing ulcer ➡️Sever trauma /Head trauma 🔺Curling ulcer ➡️after burning