امتياز الغلابه🤓🧠

Acute Pancreatitis

#Biliary_colic

Presentation:

Fourty fatty female Present with RT hypochondriam or Epigastic pain colic or dull aching in character radiate to LT shoulder and upper left back increased with fatty meals decreased with anti spasmodic last for 4 h

PLUS
Nausea vomiting hx of gallbladder stones Dyspepsia to fatty meals
FHMA in acute cholecyctitis
There is a difference between acute cholecyctitis and Biliary colic listen the record

Examination:

Palpate the abdomen tenderness rebound tenderness guarding rigidity +ve murphy sign in acute cholecyctitis

Investigation:
We can do labs like AST ALT Bilirubin lipase amylase to exclude DD and complications.
Imaging like U/S and CT scan is the diagnostic.

Don't forget exclude the DD of RT hypochondriam and Epigastic abdominal pain by Hx and Examination and investigation

Management:

Resuscitate the patien then admission for surgery.

Antispasmodic
PPI
Antiemetic
Analgesic

Home treatment till do surgery
Antibiotics[Gram -ve] in acute cholecyctitis
Analgesics
Antispasmodic
Rowchole or Bilichole for stones

Biliary colic and Acute cholecystits

#Dyspepsia

Diagnosis with exclusion of other Epigastic abd pain

Patient present with Epigastic abd pain in Gastritis and peptic ulcer or chest pain in GERD.
Pain burning or dull aching pain in character.
Loclized or radiate to the back in peptic ulcer.
with nausea vomiting heartburn dysphagia water brush mouth ulcer hiccups education.
May be present with complication of peptic ulcer like hematmasis melena.
GERD specifically may present with athma exerbation symptoms and cronic cough.
GERD is the second most common cause of chest pain be aware of that.
Past Hx of Gastritis not the first time.
Come in all age.

Risk factors :
Stress or smoking or spciy food or analgesics or fatty meals or H.Pylori

Emergency Treatment :
H2 blocker or PPI
Anti emetic like metaclopramide or ondasteron
Anti spasmodic

Clinic Treatment :
Good life style in eating very important.
Antacids or H2 blocker or PPI for 2 weeks at least may exetend ot 1 m
40 once daily before meals
20 twise daily before meals
May give two PPI or give 40 mg twise per day according to the severity of the case.
GIT regulator [ anti emetic ] like metaclobramide or ondasteron or itopride or dompridone take 3 times per day before meals for at least 2 weeks or 1 m.
Anti spasmodic 3 times per day till the pain disappear.

IF suspect in H.Pylori make H.Pylori ag in stool.

H.Pylori Treatment :

Calrathmycin 500g twise per day
Or levofloxacin 500g twice per day.
And metriandzole 500g 3 times per day or Amoxacilin 1g twise per day.
And PPI 40 once per day or 20 twise per day before meals.
This course of Treatment for at least 2w or 1m.

#طوارئ_باطنة
ومتنساش ديماً
#خدها_ببساطة😁

Dyspepsia [ Gastritis and GERD and peptic ulcer ]
Emergency and clinic

بكرا ان شاء لله هنبدأ شرح جزء من المواضيع الي اتكلمنا فيها في اخر ريكورد

#DD_for_abd_pain
First examin and locate the site of pain
Then think in the differentials in this area

Epigastic :

MI
Dka
Both must be excluded
Pancreatitis
Biliary colic
Gastritis or peptic ulcer or GERD
Gastroenteritis
AAA [ abdominal aortic aneurysm ]

RT hypochondriam :

RT lower lober pneumonia
Biliary colic
Hepatitis

LT hypochondriam :

Pancreatiits or Pancreatic cyst
Splenic abess

Periumblical :

Early appendicitis
Gynecological causes

RT and LT paraumblical :

Urological causes [ UTI or stones or crystals or gravles ]
Gynecological causes

Suprapupic :

Urological causes mostly UTI
Testicular torsion
Acute urine retention
Gynecological causes

RT iliac :

Appendicitis first must be excluded
Urological causes
Gynecological causes [ Ectopic pregnancy or complicated ovarian cyst or Polycystic ovary disease or Fibroid tumor or Pelvic inflammatory disease or mensuration ]

LT iliac :

IBS
Constipation
Diverticulitis
IBD

RT and LT loin :

Urological causes mostly stone
Gynecological causes
Siatica
Musculoskeletal

Keep in your mind
Mesenteric vascular occlusion
Intestinal obstruction

#طوارئ_باطنة
ومتنساش ديماً
#خدها_ببساطة😁

اسف علي تأخير
وريكورد طويل بس لامم ان شاء لله اغلب المواضيع
ومتنسوناش من دعائكم لوالدي رحمه لله عليه 🤍

ان شاء لله الموضوع جاي هنتنقاش في
Most common differencial diagnosis of abdominal pain

#Note
Old age come with hx of NSAID for along time make renal function test

#طوارئ_باطنة
ومتنساش ديماً
#خدها_ببساطة😁

#Fits

First of all be sure that true fits or pseudo fits
By hx

After that search for the cause
Epilepsy
Or
Chest cardiac renal liver brain
Metabolic
Then

Vitals
RBS for hypoglycemic coma
Temperature
Then

Investigation
CT brain or chest
Full lab

Treatment
Neuril
Valium
Dormicum
Tirtam

#طوارئ_باطنة
ومتنساش ديماً
#خدها_ببساطة😁

#Hypertensive_crisis 🤕

Above 180 / 110
First exclude end organ damage on brain [ stroke , hypertensive encephalopathy, brain edema ]
Eye [ papliedema , sub conjuctivial hemorrhage ]
Chest [ MI , Pulmonary edema , Aortic dissection ]
Kidney [ AKI ]

Hypertensive emergency mean end organ damage
Hypertensive urgency mean no end organ damage

Investigation :
According to the complication

Treatment:
Hypertensive emergency refer to ICU
Hypertensive urgency capton 25 sublingual every 30 minutes up to 3 doses ( 75 )
Then nitroderm patch 5

#Hypotension
90 / 60

Differential :
Vasovagal attack
Anemia
Postural hypotension
Cardiac
Bleeding
Vomiting
Diarrhea

Treatment :
Saline 500
Then take midodrin or corsore
Or vascon tab
3 times per day every 8 h for two weeks