Causes of burns and treatment

Causes of burns and treatment

burn injuries often result in profound physical and metabolic insult those most at risk include alcoholics epileptics drug addicts and mentally handicapped .children under six are most liable to scald injuries from bath water hot drinks

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Medical and surgical treatment of piles

  
Medical and surgical treatment of piles

Treatment of piles can be divided into

 conservative medical

Treatment indicated in first and early second degree piles as well as in long term management after treatment of other degree this relies mainly on avoiding constipation and straining as well as increase dietary fiber intake local application of astringent creams like xyloproct give moderate symptommatic relief to  symptoms also give analgesics laxatives and antibiotics and rest in bed those in case of prolapsed piles also use lead subacetate lotion applied to piles 2 hourly for 24 hours to relieve the edema manual dilatation of the anus under anaesthesia (lord) can be used for patient with prolapsed

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Causes and diagnosis of haemorrhoids or piles

 Causes and diagnosis of haemorrhoids or piles

First the piles are classified into according to their location in the anal canal into

Internal piles

Above dentate line their vessels arise from superior haemorrhoidal plexus they are covered with pink rectal mucosa

 Below the dentate line their vessels arise from the inferior haemorrhoidal plexus they are covered with violet anal mucosa or skin

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basic lesion of the skin

basic lesion of the skin

lesions of the skin may be primary or secondary 1- primary lesions as these are the original lesions of the skin diseases as 1- macule a cicumscribed alteration in the colour or texture of the skin less than 1cm in diameter 2- patch a macule larger than 1 m in diameter 3- papule a circumscribed palpable elevation less than .5 cm in diameter 4- nodule a solid mass in the skin similar to the papule but more than .5 cm in diameter 5- plaque an elevated area of skin 2 cm or more in diameter 6- vesicle or blister a fluid filled lesion less than .5 cm in diameter 7- bulla a fluid filled lesion larger than .5 cm in diameter 8- pustule small elevation of the skin similar to the vesicle but containing purulent material 9- wheal or weal evanescent edematous elevations of the skin of varios sizes it is characteristic lesion of urticaria 10- comedo or blackhead a plug of keratin and sebum in a dilated pilosebaceous orifice is characteristic lesion in acne vulgaris 11- burrow a small tunnel in the skin ,livear ,s shaped 3-5 mm in length and found in patient with scabies 2- secondary lesions these have developed from modification of primary lesions by regression ,infection ,or trauma as 1- scales dry or

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Structure and function of skin

Structure and function of skin

The skin is composed of three layers epidermis dermis and subcutaneous tissue

 Epidermis

Which is the outer layer of the skin it is composed of three basic cell types keratinocytes ,melanocytes ,and langerhans cells the keratinocytes or squamous cell is the principal cell of the epidermis the epidermis is divided into four main layers

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Abdominal examination by palpation for swelling

Abdominal examination by palpation for swelling

abdominal examination for swelling if a palpable swelling is present we must note its general characters as position size shape surface edge consistency mobility and movement on respiration the swelling may be an enlarged organ as in spleen kidney liver and gall bladder or tumour as in carcinoma of colon the sausage-shaped swelling of the intussusception or

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Abdominal examination by palpation for tenderness and rigidity

Abdominal examination by palpation for tenderness and rigidi
   as we mentioned before the methods of abdominal examination by palpation we know talking about the following sign which should be searched carefully during abdominal palpation 1- abdominal tenderness before palpating for tenderness ask the patient to point to the painful area if he is not definite about it ask him to take a deep breath or cough when a sharp increase of pain helps him to locate the tender

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Local examination of acute abdomen by palpation

 

Local examination of acute abdomen by palpation

Local examination of  the abdomen by palpation unless you are

 left handed always stand by the right  side of the patient during palpation of the abdomen make sure that the abdominal wall is as lax as possible and that your hands are warm tell the patient to bend up the knees and the put a pillow underneath them to take the weight of the legs ask him to open the mouth and

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Local examination in acute abdomen

Local examination in acute abdomen

These included the following items 1- inspection 2- palpation3- percussion 4- ausculation5-rectal examination 6- vaginal examination first we star by inspection the patient should be lie flat on his back with the body fully exposed from nipples above to mid thighs below 1- contour we note any asymmetry distension or visible swelling if there is any asymmetry make sure it is not due to faulty posture or disease of the spine

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General examination in acute abdomen

General examination in acute abdomen

we will discuss the general examination which should be done with every patient with acute abdomen as follow 1-facies observe the patient closely for any peculiar facial expression which might suggest a certain clinical condition as the sunken eyes drawn checks pinched nose and dry skin are characteristic of dehydration also the deathly pallor anxious expression and air hunger suggestive of internal haemorrhage and the bright hollow eyes cold clammy forehead collapse temples dry lips and tongue and anxious

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VOMITING IN ACUTE ABDOMEN

VOMITING IN ACUTE ABDOMEN

we will discuss the vomiting symptoms in case of acute abdomen because it is an important and give us good idea about the causes of the disease as follow we note it is onset frequency and character and the amount and composition of the vomiting 1- onset and frequency in most case of acute abdomen vomiting occurs once or twice soon after the onset of the pain early frequent and profuse vomiting is suggestive of acute intestinal

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ANATOMY AND BLOOD SUPPLY OF APPENDIX

 ANATOMY AND BLOOD SUPPLY OF APPENDIX  

  Appendix where it is located it is located in the right iliac fossa which it is originates from postermedial side of the cecum about 1.7 cm from the end of the ilium the base of the appendix is located at the union of the tenia for all practical purposes the anterior tenia will end at the appendiceal origin which it is very important to detected the site of the appendix because in some cases we find difficulty to see it so we follow this tenia coli to find it   mesentery the mesentery of the appendix is derived from the posterior side of the mesentery of the terminal ileum it attaches to the cecum as well as to the proximal appendix and contains the appendcular artery which is very important and must be ligated when doing appendicetomy otherwise postappendictomy haemorrhage will occur appendicitis means inflammation of the appendix which most common causes are feacolith mean stool impact at the lumen of the appendix causing it is obstruction and this type of inflammation consider dangerous one because the appendix become liable for rupture rapid more than any type and need urgent operation other causes by lymphatic from the

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ACUTE ABDOMEN

 

ACUTE ABDOMEN

Acute abdomen means is the term applied to any abdominal emergency need for urgent relif since an immediate operation is often necessary

 what are the differential diagnosis of acute abdomen

we can classified it to

1-Colics as intestinal renal biliary appendicular  pancreatic

 2-Acute inflammation as acute appendicitis cholecystitis panctreatitis diverticulitis regional ileits enteroclotis pyelitis salpingitis non specific mesenteric lymphadenitis iliac adenitis

 Perforations -3

As perforated peptic ulcer typhoid ulcer

4-Peritonitis

 Either primary or secondary

 5-Intestinal obstruction 

Like simple occlusion strangulation paralytic ileus

6-Internal haemorrhage 

As ruptured spleen ectopic pregnancy ovarian cyst or aneurysm

 7-Torsion as twisted ovarian cyst torsion of omentum

8- Referred pain as chest spine

 9- General diseases as uraemia diabetes typhoid malaria abdominal influenza

Now will be discuss the pain in details because it is very important which can lead you to proper and rapid diagnosis as we see now the pain is usually the first and most important symptoms we should investigated it as follow 1- onest of the pain you should note the exact time of the onset and whether the trouble started during sleep as in acute appendicitis after meal perforated peptic ulcer in the middle of the day as colics follow some special exertion as in strangulated hernia also we should be asked about the mode of the onset whether sudden as in haemorrhage or perforation or gradual as in

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TREATMENT OF APPENDICITIS

                                                                                                                                                        TREATMENT OF APPENDICITIS

               we can say once appendicitis always appendicectomy there no medical treatment for acute appendicitis so never describe medical treatment for acute appendicitis because this can lead to  a major complication and u transfer the case from simple appendicectomy  done within minutes to right hemicolectomy which may be fatal  so be serious please this is the patient life and u deal with human being also never describe any analgesic in patient with acute abdomen like appendicitis

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CLINICAL FEATURES OF APPENDICITIS

 CLINICAL FEATURES OF APPENDICITIS

 Symptoms of appendicitis which mean the complaining of the patient or what patient feel he feel first diffuse abdominal pain start around the umbilicus then become localized in the right iliaic fossa this the typical symptoms also patient suffer from nausea and anorexia which is very important symptoms in case of appendicitis u can also say no appendicitis without anorexia there is mild fever in the beginning also may associated with vomiting especially in obstructive type of appendicitis sometimes patient complain from diarrhea this symptoms must take you to pelvic appendicitis because the appendix make irritation to the rectum give feeling of diarrhea don not forget this also when feeling tensmus u must think in associated pelvic abscess  low  grade fever unless it is complicated become high fever sometimes patient feel pain in the right hypochondrium mimic acute

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SURGICAL TREATMENT OF OBESITY

1. SURGICAL TREATMENT OF OBESITY
    
    Surgical treatment
   
   That after failure of all other methods like diatery changing exercises and activity behavior changes and medical treatment and also in superobseity and if obesity start to make complication so it should be  interfere
   
   

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Management of obesity

Management of obesity

 
 management of obesity

Can be classified into  medical and surgical treatment when we used surgery in obesity? that after1- failure of all medical treatment which  will describe it on details  latter and also when 2- body mass index (BMI ) more than 40 because in these cases obesity threatening the life and can causes major problems

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Causes and measurements of obesity

Causes and measurements of obesity
 
Definition

   Obesity  means 20% or more increase body weight more than normal due to excessive fat deposition in the subcutaneous and deep tissues due to increase activity of fat cells and increase it number obesity can be assessed by the thickness of the skin folds measured by special instruments as 1- lateral aspect of arm =0.9-1.1cm 2- abdomen =1-1.5cm buttocks =1.5-2.5 cm when we can say that person obese or no by method of body mass index (BMI) when become more than 30kg|m squared  BMI=WT in kg /HI in m squared so according to BMI  it can be classified the obesity as BMI=18-20 that is normal BMI=25-30 means overweight BMI more than 30 called obese and BMI over than 50 called super obese what are the problem

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