شوية نوتس مهمة في الراوند التاني:
➡️causes of tender splenomegaly:
(TIBS)
typhoid
typhus
infective endocarditis
brucella
septicemia
➡️Rolling technique
➡️causes of splenomegaly and hepatomegaly
➡️cullen sign, grey Turner sign (causes)
•acute hemorrhagic pancreatitis
•rupture spleen
•endometriosis
➡️dilated and visible veins:
dilated(elevated, tortuous)
➡️milking test:
•portal HTN (away from umbilicus»caput medusa)
•SVC obstruction (sup)
•IVC obstruction (inf)
➡️umbilicus: expensile impulse on cough(والعيان نايم والعيان واقف)
بيسألوا على الحتة دي
➡️abdominal contour:
1•scaphoid/distention
(localized:
causes سؤال هنا:
small bowel obstruction
organomegaly
mass
hernia
generalized: 5Fسؤال هنا )
2•flank(full, empty, bulging)
3•contour (regular, irregular)
➡️causes of wide /obtuse subcostal angle:
sustained increase intra abdominal pressure
•hepatomegaly
•splenomegaly
•ascites
➡️Drugs cause gynecomastia:
•cimetidine
•digitalis (inotropic agent)
•spironolactone(k sparing diuretics)
➡️2 not visible:
•epigastric pulsation
•intestinal movement
مينفعش تقول absent
➡️وأنا بعمل confirmation للepigastric pulsation:
ممكن ايدي تخبط في 3أماكن:
من تحت:
Aortic mass or aneurysm
من الtips:
rt sided HF
من جهة الliver:
tricuspid regurge or stenosis
#practical
#internal_medicine
