
Dr.Laith Harbauy session 3
31/7/2016
Cases Have been seen
1-Paraumbilical Hernia .
2-post.op. appendecectomy
3-post.op. laproscopic cholecystectomy
4-post.op. open cholecystectomy.
5-Diabetic foot presented as ulcer (Ulcer Ex.)
5-signs of A.Appendicitis done on a volunteer .(1-tenderness 2-rebound tenderness
…………….)
الخ
المعلو
م
ات حول هذا المواضيع كلها متوفرة في
المحاضرات النظرية والف
حص العملي بالمالزم العملية المعتمدة
(ريمكس
&
general surgery for medical students
)
Notes:
1-what's 1st think U have to do in Ex. Of pt w/t hernia ?
2-what's consistency &auscultation result of omentum containing
paraumbilical hernia ?
3-what's relationship of DM w/t hernia?
4-how to prepare pt w/t DM for surgery ?
5-what're the difference b/t herniotomy & herniorraphy &
hernioplasty ?
6-what's the 5H in Ex. Of ulcer ?
7-FMF (familial ? ? )
8-type of fluid to be given for pt underwent appendectomy ?
Why?
9-why do we forbid post.op. from drinking fluid in 0 day ?
10-ERCP-therapeutic complications ?—
pancreatitis\&cholangitis& septecemia
11-T-Tube rules ? When is it used ?-should remain 7-10 day
then do cholangiogram if there is stone ,if not remove
it.used after cholecystectomy in CBD containing stone.
12- where are places of laproscopic holes ?
13-where's working port & teloscopic & illumination one?
-Rt subcostal---assistant
-supra-umbilical---camera
-supxiphoid----- surgen who working

1-1st should be in stand position
2-doughy consistency, no bowel sound, compare with bowel sound at iliocecal junction
3-DM should be control because Hernia will treated by mesh which has risk of infection
4-blood sugar level about 100mg /dl
5-herniotomy .removal..done under 16years,,, hernioraphy repair infandibulum,,,
hernioplasty ...by mesh
6- it is 5 edges
Slop ,pounched out,,indurated,rolled ,everted
7-FMF:famelial medetrenian fever
8- glucose water or glucose saline ,because of salt retention due to ADH
9-due to ileus it will cause pt. to vomit
-any fever in tube )regardless type of it is d/t
infection
1-uretric colic 2-bronchopneumonia 3-biliary clic
-Laproscopic cholecystectomy is standard now aday
but still open cholecystectomy is used ?especially in
e absolute contraindications for
Th
?
female why
laparoscopic cholecystectomy from the 1980s
(pregnancy, previous abdominal surgery, bowel
obstruction, coagulopathy, obesity, cirrhosis,
inability to tolerate general anesthesia,
choledocholithiasis, and acute cholecystitis) have
become today's relative contraindications.
هاي ما من
الدكتور من موقع
medscape
Types of appendecectomy incision? How done ?
–
McBurney's incision, also
)
1
?
hole incision
-
Bottom
known as grid iron incision 2) Lanz incision 3)
Rutherford morrision 4) Paramedian incision
By H.A.Abdulkarim + Hiba Hani
------------------------------------------------------------------------------------------------------------
By Hiba F.
Ex of appendix preoperative
1) inspection
_ see respiration
_ ask the patient to point the site if pain
_see scar, dilated viens.
_ ask him to cough at the end of inspection ( to see hernial orifice, to localize the site of pain
called re_ cough tenderness )
2) superficial palpation
_tenderness
_ rebound tenderness
_ rovsing sign ( pressure on the LIF cause a pain in RIF )
_ soas sign ( extension of the leg)

_obturator sign
______________________________
** ex. Of hernia
1)inspection
_ ask the patient to stand up position , or on lying position if he can't.
_ask the patient to cough
2) palpation
_reduce the hernia
_obliteration test
3) no percussion
4) Auscultion
_bowel content.
** case of para umbilical hernia discreption
1) Inspection
Swelling around the umbilicus , measures 5 cm
_ no umbilicus mostly removed by other surgery .
_ no visible pulsation
_there is cough impulse.
_there is scar
2) palpation
_Difficult to reduce
_ Doughy consistency
_palpable cough impulse
3 ) auscultion : negative at omentum But positive at iliosecal
** Treatment. Herniotomy & hernioraghy
_______________________________
** exm. Of foot
Role of foot.( Look , feel , move)
** Discreption of leg
_Swelling of the leg specially at the dorsum
_rounded lesion about 6 cm
_edges ( slopped , punched out, everted , rolled )
*
هينا ماشفنا ا
ل
edge
ا
ﻻ
صلي
ﻻ
ن الجرح منظف ( كان
slopped
_ induration
_ palpation ( pulse)
** exm. Of ulcer
Site

Size
shape
surface
edge
floor
roof
induration
Pulse
Sensation
Area around ulcer.
-