My Medical journey💉💊

⭕️ Internal vs External fixation #orthopedics

HIP SPICA #orthopedics

⭕️ BONE FRACTURES #orthopedics #notes

📝Questions to ask in Jaundice: -OCD (Onset, Course, Duration) -Pain (SOCRATES) -Fever -Weight loss -Nausea -Dyspepsia -Mucosal bleeding -Pruritis -Stool~ color & odor ‐Urine~ color & odor -CNS~ mental status 🖇In calculus obstructive jaundice pain is: Colicky in character, radiated to right shoulder, aggravated by fatty meal and relieved by medication. #Clinical_surgery #Level_4

💭Gallbladder stones [Biliary colic]: Acute in onset, severe, colicky pain in the RUQ. May radiate to the epigastric region, right shoulder and right inferior angle of scapula. ~Systemically well. 💭Cholecystitis: Constant RUQ pain. May radiate to the epigastrium and/or right shoulder and right inferior angle of scapula. Pain is worse on deep inspiration. ~Usually systemically unwell. 💭Acute cholangitis: Charcot’s triad of RUQ pain, fever and jaundice. ~Systemically very unwell (fever, hypotension, tachycardia, tachypnoea, rigours). 📌To differentiate between acute cholecystitis and chronic cholecystitis: In Acute Cholecystitis; 1. Pain constant for more than 6 hours. 2. Retching / Vomiting. 3. Murphy's sign. #Clinical_surgery #Level_4

Charcot’s Triad: 1. Fever and chills. 2. Jaundice. 3. Right upper quadrant (RUQ) pain. Reynold’s Pentad (Seen in severe cases): Includes the above three, plus hypotension and altered mental status.

Courvoisier’s law states if a patient presents with jaundice and they have a non-tender, palpable gallbladder on examination, the cause is unlikely to be due gallstones. This is because gallstones form over a prolonged period, which results in a shrunken fibrotic gallbladder which does not distend easily. As a result, jaundice and a palpable gallbladder should raise suspicion of malignant obstruction of the biliary tree (e.g. pancreatic cancer).

Mirizzi’s syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common bile duct (CBD) or common hepatic duct, resulting in obstruction and jaundice. Obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis (inflammation).²

🔷Murphy’s sign is elicited by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to breathe in. ~Normally, the abdominal contents are pushed downward during inspiration as the diaphragm moves down. The test is considered positive if the patient stops breathing in and winces with a ‘catch’. The same manoeuvre must not elicit pain when performed on the left side for the test to be positive.