Station 1 the ptn developed fever. Tachycardia, tachypnea & generalized abd pain :

a)Explain ? a)Dx ? c) List 4 causes ? d) What u will find in Ex? e) 4 initial Rx ?

A)Explain: Erect CXR /AXR shows radiolucent crescent of air below the diaphragm,should b looked at above the live( on the rt side) 1- The chest 2- the upper part of the abdomen b)Dx :air under the diaphragm ( pneumoperitoneum)

c) List 4 causes ? NB. This pnt presented w grn abd pain.. So peritonitis is likely 1-Perforated hollow viscus ( peptic ulcer, IBD, meckles, diverticulitis…). 2-Peritoneal infection with gas-forming organisms, or rupture of adjacent abscess. 3-Chemoembolization of liver tumor. 4-Iatrogenic (recent abdominal surgery, leaking surgical anastomosis, post peritoneal dialysis, dilatation post colonoscopy, post ( percutaneous needle biopsy of any organ(eg. Liver).

d) What u will find in Ex : 1- Inspection: abdominal distention, restricted respiratory movements: pnt lies still) 2- Palpation: reluctance, very tender, peritonism ( rigid,board-like, rebound) 3-percussion: tender, resonant 4-auscultation:Absent bowel sounds if peritonitis e) 4 initial ttt : of course after good H&Exam…. Admit,NPO +fluid resuscitation,antibiotics + analgesics/antipyretics, take to theater if unstable or rapidly progressing and u have a suspicion of perforation or internal bleeding.. ( not sure 100%)

Station 2 *DESCRIBE? *what's the diagnosis? * give three symptoms of such case ? *give three signs of such case.?

*DESCRIBE: Picture of chest x-ray with depressed dome of diaphragm in the Right side with black shadow(air) *what's the diagnosis?? ( Tension ) Pneumothorax Tension if: shifted mediastinum, hyperlucent & overly expanded hemithorax *give three symptoms of such case ? Chest pain, SOB, palpitations, dizziness *give three signs of such case? Tachypnea, tachycardia, hypotention,ipsi decreased chest expantion +hyperresonance+decreased breath sounds

Station 3 X-ray shows the lung : a)Dx b) Immediate life saving Rx : c) 3 findings that u can see in the X-ray: d) 4 clinical features=

a)Dx : tension pneumothorax. b) Immediate life saving Rx : Thoracocentesis with a needle in the 2 nd intercostal space midclav line then put on chest tube. c) 3 findings that u can see in the X-ray: Hypertranslucency, shifted mediastinum, lung retracted from thoracic wall, widened intercostal spaces. d) 4 clinical features= S&S mentioned in prior slides.

Station 4 X- ray for the large bowel ملاحظة ترى الصورة اللي جات ما تشبه هذي ،، بس هذي الصور طلعتها من النت للكرونز

a)Dx : (they said its crohns' But I don’t know ) b) 3 structures of the organ that u can see in the picture : I did not exactly understand the question but,, I think they mean what r the barium study findings of CD: multiple narrowing and stricturing esp involving the terminal ileum: ( string sign) may also cause findings of bowel obstruction, deep knife like linear clefts ( cobblestoning), fistula tracts, fissures. Or they mean anatomy so u say cecum ascending colon transverse …. Alyaa

c) Name the procedure : X- ray with barium enema I think with barium enema it is UC and not CD For CD we need a small bowel enema or a small bowel follow through. Alyaa

It is also worth mentioning the prominent findings in UC ( barium enema ) : ulcers of variable shapes : collar button, double tracking ), colonic narrowing, shortening, and dilatation(toxic megacolon), multiple psuedopolyposis ( multiple filling defects), Symmetrical thickening of haustral folds may produce the appearance of thumbprinting, stricturing of left colon.. Alyaa ** Findings of bowel obstruction: 3 cardinal ( a triad of ): 1)Proximal dilatation( small bowel loops > 3cm, cecum > 9 cm, transverse+descending+sigmoid > 5cm). 2)Distal narrowing and loss of gas pattern distally ( paucity of air distally). 3)Multiple air fluid levels in the erect ( upright ) film. Alyaa

Causes of LBO: Colonic Carcinoma (65%) Diverticular disease (10%) Volvulus (5%) Crohn’s disease Hernia Strictures: Ischaemic, anastamotic, inflammatory etc *In comparison, Causes of SBO in order: 1- adhesions ( bands) 2- hernia 3- neoplasms …..Alyaa i put my name on slides I added so that anyone can refers to me,, I advice u to check out x-rays of obstruction, IBD, colon CA..