Abscess Management Open DrainNOT antibiotics Antibiotics after primary

Abscess *Management: Open + Drain(NOT antibiotics). *Antibiotics after primary management indications? 1. Immunocompromised 2. Sepsis 3. Deep tissue infection *Next step? Irrigation with iodine & Recurrent dressing ﻣﻨﺴﺘﺒﺪﻟﻪ ﺏ ، ﺑﻌﺪ ﻣﺎ ﻧﻨﻈﻒ ﺍﻟﺠﺮﺡ ﺑﺎﻟﻴﻮﺩ saline ﻋﺸﺎﻥ ﻣﺎ ﻳﻌﻤﻞ tissue injury. Fistula with seton

Abscess *Description: Red , Round area , located in the left lower mandible below the ear lobule Most likely Abscess. *Management: Open & Drain. *Any danger? ? 1. Facial. N injury Antibiotics indication 2. Deep tissue infection 3. Neck arteries & trachea lacation *Most common organism? Staph. epidermis *Antibiotics? Any gram-positive directed antibiotic

Anal discharge in the left buttocks *DDx: Fistula *Management: Depends on the type: If low Fistulotomy If high Seton insertion , and next? Seton repositioning *Primary cause ? Previous perianal abscess *Risk factors for poor healing? -DM -Resistant infection -Immunodeficiency cases , eg; cancer/AIDS -Nutrition status -Age -Smoking -Foreign body -Low fistula -Hygiene

Stoma *Type? Ileostomy *Content? Fluid (Succus entericus) *Description of the scar? Midline[longitudinal] and transverse laparotomies * Keloid OR Hypertrophic? ﺣﻜﻰ ﺍﻧﻪ ﻫﺎﺩ plastic ﺍﻛﺜﺮ ﺑﺲ ﻫﻴﻚ ﺣﻨﺎﺧﺪ plastic ﻓﺸﻮﻓﻮﺍ ﺍﻟﺼﻮﺭﺓ ﺍﻟﻲ ﺗﺤﺖ ﻫﺴﺎ ، ﺑﻌﺪﻳﻦ Ileostomy Colostomy Site Right Left Contents Fluid(succus entericus) Stool

PNS [Pilonidal Sinus] *Management? Excision *If becomes infected , what is it called? Abscess , Management of abscess then? Incision and drainage

Pus *Next step management after drainage (as seen) if the patient is healthy wealthy? ﻳﻌﻨﻲ ﻣﻨﺎﻋﺘﻪ ﻋﺎﻝ ﺍﻟﻌﺎﻝ (No indication for antibiotics) 1. Dressing 2. Irrigation ﺑﻨﺤﻜﻲ ﻟﻠﻤﺮﻳﺾ ﺍﻧﻬﺎ ﺑﺘﺴﻜﺮ ﻟﺤﺎﻟﻬﺎ ، ﻭﻣﺎ ﻣﻨﺴﻜﺮﻫﺎ

Hernia *Management? 1. (If NO tenderness & NO skin changes: Try to push in. ! ﺍﺫﺍ ﻛﺎﻥ ﻓﻴﻪ ﺗﻐﻴﺮ ﺑﻠﻮﻥ ﺍﻟﺠﻠﺪ ﺍﻭ ﻭﺟﻊ ﻣﻊ ﺍﻟﻀﻐﻂ ؟ ﻣﺎ ﺑﺘﺠﺮﺏ ﺗﺮﺟﻌﻬﺎ ﺍﺑﺪﺍ ﻟﻴﺶ؟ ﻋﺸﺎﻥ ﻣﻤﻜﻦ ﺗﻜﻮﻥ Infarcted ﺷﻮ ﺍﺳﻤﻬﺎ ﻫﺎﻱ؟ Strangulated hernia. 2. Best hernia approach? Repair=Tension 3 repair, using a mesh. *Types of hernia? -Femoral -Inguinal(direct/indirect) -Umbilical(child)/paraumbilical(adult) -Epigastric -Sciatic *Possible hernia contents? -Small bowel/Large bowel or both -Omentum -Stomach -Sigmoid (most likely inguinal) -Ovary & fallopian tubes (most likely if young female) -Incisional -Spigelian -Hiatal -Lumbar

-Painful *Management? MPO/IV Fluid/IV Antibiotics/NG tube ﻭﺑﺠﻬﺰﻩ ﻟﻠﻌﻤﻠﻴﺖ *If perorated/bleeding ulcer? -Duodenal: Graham patch -Stomach: Billroth procedure Air under diaphragm

-Multiple air/fluid levels *Causes: -Adhesions -Hernias -intussusception -Mass -Stricture/Bands -Ileus *Primary management? MPO/IV Fluid/IV Antibiotics/NG tube *Specifically for intestinal obstruction? Diagnostic laparotomy *If the cause is hernia? ﺍﻟﺴﻼﻳﺪﺍﺕ ﺍﻟﻲ ﻗﺒﻞ ﺍﺫﺍ ﻣﺎ ﺍﻋﺘﺒﺮﻩ ﺳﺆﺎﻝ ﻣﺮﺍﺟﻌﺔ ﻭﺗﺬﻛﺮ ﻣﻦ ﻋﺮﻓﺖ *If the cause is mass? Excision(resection)&Stoma Intestinal obstruction

-Toxic abdomen with severe pain *Management: Surgery (laparotomy) *If the patient prefers not to administer surgery ? ﻏﺎﻟﺒﺎ ﻫﻴﻚ ﻣﻦ ﻫﻮﻥ ﻷﺘﺄﻜﺪ ﻟﻜﻮ ﻣﻦ ﺍﻟﺪﻛﺘﻮﺭ ﺑﺲ ﻫﻮ ﺑﺎﻟﻤﺤﺎﺿﺮﺓ ﺣﻜﻰ ﻋﻦ ﺍﻟﻲ ﺗﺤﺘﻪ ﺧﻂ ﺍﺣﻤﺮ Sigmoid volvulus

Paleness Rigid abdomen Intestinal obstruction with dilated small bowel Management? MPO/IV Fluid/IV Antibiotics/NG tube ﻭﺑﺘﺤﻀﺮﻩ ﻟﻠﻌﻤﻠﻴﺎﺕ

*Type of study? Barium-swallow *Finding? Pouch = Zenker diverticulum *Management? Excision Zenker diverticulum