logging in or signing up Interesting surgical cases x-ray waleedfawzy Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 605 Category: Entertainment License: All Rights Reserved Like it (2) Dislike it (0) Added: April 01, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: ashokgswaminathan (14 month(s) ago) good presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: rigmarole_2001 (23 month(s) ago) It is a very comprehensive and informative presentation. I would appreciated if you could allow me to download this presentation for the benefit of my students. Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript CASES REVIEW : CASES REVIEW Dr Abdul Kareem Al Mowiel General Surgeon Zhahran Al Janoub Hospital Case 1 : Ali Gufran Omaish, 3 y/o M, Saudi. Admission on 27/12/1428 Hx of Fall From Hieght ( > 4 m) Clinically, vital signs were stable and the patient is fully conscious and oriented. GCS score: 15/15. No significant complaints, only mild to moderate abdominal pain and distension. Clinically, there was mild abdominal tenderness and distension with noramal chest examination, lab and US scan of the abdomen. Abdominal X ray: . . . .. Case 1 Management : Management IVF (LR 40 ml/hr), fortum 25o mg X3, Adol Supp, 250 mg sos. On the next day: patient became absolutely normal clinically and radiologically. No pain or other complaints, and the patient tolerated oral feeding. The patient was discharged on 28/12/1428 Post-management, supine : Post-management, supine Post-management, Erect : Post-management, Erect I saw this view of stomach dilatation in many cases and treated conservatively Case 2 : Bushra Mushabab 4 y/o f saudi Admitted on 13/3/1431 at 04:45 pm Presentation: severe abdominal pain with distension and absence of bowl movements over 16 hours, history was unclear regarding passing flatus. Clinically: vital signs were stable and the patient afebrile, the abdominal was tense and distende, PR examination was not done as she was a young girl. Primary Dx: INTESTINAL OBSTRUCTION. Tx: N.P.O, NG Tube, I.V.F, IV Ceftriaxone 250 tds. Investigations: routine lab and abdominal US Scan : N.A.D Erect and supine X ray s . . . Case 2 Slide 7: Differential Dx: Congenital pyloric stenosis, because there is Hx of abdominal distension past meals eating Tricho Bezoars, but no Hx of F body ingestion. Patient’s relative refused inserting NG tube and the patient left DAMA. Case 3 : Nora Ahmed Saed, 8 y/o F Saudi, presented on: 8/8/1427. c/o: abdominal pain and constipation. Hx of stones ingestion for years. Clinically: patient was pale , thin, short and looked 5 years old. Abdomen: soft with mild tenderness but no signs of acute abdomen. Lab. Investigations: normal TLC , Hg: 9.4, Hct: 28.3. other investigations: NAD X ray: the whole GI tract is impacted with stones from the stomach to the rectum. Case 3 Management: : Management: Mild manipulation of the rectum. High fiber diet. Observation. Next Day: : Next Day: 9/8/1427: Patient passed a lot of stones but still there is some stones . . . . Then . . : Then . . 10/8 / 1427: Soft abdomen and no complaint. Abdomen X ray: no stones in GIT Patient was readmitted 3 months later with the same complaint and treated similarly Case 4 : Safer Saed 34 y/o m Saudi This prisoner was brought by policemen on 10/1/1429 complaining of abdominal pain. There is Hx of ingestion of unknown objects. Clinical examination: normal including abdomen, chest and vital signs. Routine lab and abdomen US scan: normal Chest X erect X ray was done to exclude perforation. Case 4 Management : Management High fibers diet and observation. Slide 17: The nails passed out Eventually : Eventually Patient was discharged on 15/1/1429 after he had passed every thing. Case 5 : Majed Moshabab Hadi Jarallah, 11y/o m Saudi. Presented on 20/2/1425. 08:30 am patient in ER c/o: dizziness, delirium, low grade fever, headache and vomiting. History of swimming in rain water a day ago. Abdominal and chest examinations were normal and the lab. Investigations were normal. Tx: Admission under pedia care as URT infection IV fluids 500 ml over 3 hours followed by 30 ml/hr, small liquid diet and Phenergan 25 mg IM Case 5 Later . . . : Later . . . 04:00 pm: patient turned comatosed with GCS sore of: 7, dilated and fixed pupils bilaterally. BP: 110/65, PR: 78, RR: 26. Ophthalmology referral revealed no papilledema bilaterally No external signs of head trauma. CT was not available. Dx: ? Encephalitis, poisoning. Patient shifted from ward to ICU NG tube inserted and gastric lavage performed. Soft diet, IVF 50 ml / hour DW5%1/2saline, ceftriaxone. 06:00 pm: Ampicilline 1 gm x 4 IV was added. 07:00 pm: Dexamethasone, Zovirax and immunoglobuline were added. And patient did not improve. CT scan : 23/2/1425: brain CT scan was performed and revealed: Ventricular dilatation. Brain tumor: 22 x 25 mm With calcifications CT scan Eventually . . : Patient was transferred to ACH in the same day Eventually . . Case 6 : Saud Jaber Duban, 18 y/o m Saudi. Presented on 8/3/1425 9:30 am c/o: abdominal pain, vomiting, loss of appetite and dizziness for 2 weeks. Clinically: temp: 36.8° BP: 90/60, PR: 62, RR: 20. Conscious, fully oriented patient looks pale, and wasted. Chest, abdomen and routine lab. Investigations within normal. Initial Tx: IV fluids, soft diet, Tagmet, and IV metoclopromide. 10:00 am: patient was still conscious and oriented and c/o back pain but no lump or tenderness. IV metoclopromide discontinued and consultation about ?? Brocillosis was requested. 05:00 pm: ophthalmology referral was done and revealed papilledema for which a head CT scan was requested. In the CT room patient arrested, cardiac arrest? Respiratory arrest? Resuscitation done and patient shifted to ICU. Case 6 In the ICU : In the ICU 07:00 pm: patient was unconscious with GCS score: 4/15, PR: 105, BP: 101/65, on ventilator, pupils are fixed and dilated. I.T.T and Foley catheter were inserted. No external signs of head trauma or injury. Chest had no signs of injury but some rashes over the upper part were noticed bilateral crepitations were found by auscultation (blood inspiration?) . CXR: normal Lax and soft abdomen but with absent bowel sounds. CT Scan : CT scan was performed and showed a brain tumor with ventricular dilatation. Patient was referred to ACH. CT Scan THANK YOU : THANK YOU You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Interesting surgical cases x-ray waleedfawzy Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 605 Category: Entertainment License: All Rights Reserved Like it (2) Dislike it (0) Added: April 01, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: ashokgswaminathan (14 month(s) ago) good presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: rigmarole_2001 (23 month(s) ago) It is a very comprehensive and informative presentation. I would appreciated if you could allow me to download this presentation for the benefit of my students. Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript CASES REVIEW : CASES REVIEW Dr Abdul Kareem Al Mowiel General Surgeon Zhahran Al Janoub Hospital Case 1 : Ali Gufran Omaish, 3 y/o M, Saudi. Admission on 27/12/1428 Hx of Fall From Hieght ( > 4 m) Clinically, vital signs were stable and the patient is fully conscious and oriented. GCS score: 15/15. No significant complaints, only mild to moderate abdominal pain and distension. Clinically, there was mild abdominal tenderness and distension with noramal chest examination, lab and US scan of the abdomen. Abdominal X ray: . . . .. Case 1 Management : Management IVF (LR 40 ml/hr), fortum 25o mg X3, Adol Supp, 250 mg sos. On the next day: patient became absolutely normal clinically and radiologically. No pain or other complaints, and the patient tolerated oral feeding. The patient was discharged on 28/12/1428 Post-management, supine : Post-management, supine Post-management, Erect : Post-management, Erect I saw this view of stomach dilatation in many cases and treated conservatively Case 2 : Bushra Mushabab 4 y/o f saudi Admitted on 13/3/1431 at 04:45 pm Presentation: severe abdominal pain with distension and absence of bowl movements over 16 hours, history was unclear regarding passing flatus. Clinically: vital signs were stable and the patient afebrile, the abdominal was tense and distende, PR examination was not done as she was a young girl. Primary Dx: INTESTINAL OBSTRUCTION. Tx: N.P.O, NG Tube, I.V.F, IV Ceftriaxone 250 tds. Investigations: routine lab and abdominal US Scan : N.A.D Erect and supine X ray s . . . Case 2 Slide 7: Differential Dx: Congenital pyloric stenosis, because there is Hx of abdominal distension past meals eating Tricho Bezoars, but no Hx of F body ingestion. Patient’s relative refused inserting NG tube and the patient left DAMA. Case 3 : Nora Ahmed Saed, 8 y/o F Saudi, presented on: 8/8/1427. c/o: abdominal pain and constipation. Hx of stones ingestion for years. Clinically: patient was pale , thin, short and looked 5 years old. Abdomen: soft with mild tenderness but no signs of acute abdomen. Lab. Investigations: normal TLC , Hg: 9.4, Hct: 28.3. other investigations: NAD X ray: the whole GI tract is impacted with stones from the stomach to the rectum. Case 3 Management: : Management: Mild manipulation of the rectum. High fiber diet. Observation. Next Day: : Next Day: 9/8/1427: Patient passed a lot of stones but still there is some stones . . . . Then . . : Then . . 10/8 / 1427: Soft abdomen and no complaint. Abdomen X ray: no stones in GIT Patient was readmitted 3 months later with the same complaint and treated similarly Case 4 : Safer Saed 34 y/o m Saudi This prisoner was brought by policemen on 10/1/1429 complaining of abdominal pain. There is Hx of ingestion of unknown objects. Clinical examination: normal including abdomen, chest and vital signs. Routine lab and abdomen US scan: normal Chest X erect X ray was done to exclude perforation. Case 4 Management : Management High fibers diet and observation. Slide 17: The nails passed out Eventually : Eventually Patient was discharged on 15/1/1429 after he had passed every thing. Case 5 : Majed Moshabab Hadi Jarallah, 11y/o m Saudi. Presented on 20/2/1425. 08:30 am patient in ER c/o: dizziness, delirium, low grade fever, headache and vomiting. History of swimming in rain water a day ago. Abdominal and chest examinations were normal and the lab. Investigations were normal. Tx: Admission under pedia care as URT infection IV fluids 500 ml over 3 hours followed by 30 ml/hr, small liquid diet and Phenergan 25 mg IM Case 5 Later . . . : Later . . . 04:00 pm: patient turned comatosed with GCS sore of: 7, dilated and fixed pupils bilaterally. BP: 110/65, PR: 78, RR: 26. Ophthalmology referral revealed no papilledema bilaterally No external signs of head trauma. CT was not available. Dx: ? Encephalitis, poisoning. Patient shifted from ward to ICU NG tube inserted and gastric lavage performed. Soft diet, IVF 50 ml / hour DW5%1/2saline, ceftriaxone. 06:00 pm: Ampicilline 1 gm x 4 IV was added. 07:00 pm: Dexamethasone, Zovirax and immunoglobuline were added. And patient did not improve. CT scan : 23/2/1425: brain CT scan was performed and revealed: Ventricular dilatation. Brain tumor: 22 x 25 mm With calcifications CT scan Eventually . . : Patient was transferred to ACH in the same day Eventually . . Case 6 : Saud Jaber Duban, 18 y/o m Saudi. Presented on 8/3/1425 9:30 am c/o: abdominal pain, vomiting, loss of appetite and dizziness for 2 weeks. Clinically: temp: 36.8° BP: 90/60, PR: 62, RR: 20. Conscious, fully oriented patient looks pale, and wasted. Chest, abdomen and routine lab. Investigations within normal. Initial Tx: IV fluids, soft diet, Tagmet, and IV metoclopromide. 10:00 am: patient was still conscious and oriented and c/o back pain but no lump or tenderness. IV metoclopromide discontinued and consultation about ?? Brocillosis was requested. 05:00 pm: ophthalmology referral was done and revealed papilledema for which a head CT scan was requested. In the CT room patient arrested, cardiac arrest? Respiratory arrest? Resuscitation done and patient shifted to ICU. Case 6 In the ICU : In the ICU 07:00 pm: patient was unconscious with GCS score: 4/15, PR: 105, BP: 101/65, on ventilator, pupils are fixed and dilated. I.T.T and Foley catheter were inserted. No external signs of head trauma or injury. Chest had no signs of injury but some rashes over the upper part were noticed bilateral crepitations were found by auscultation (blood inspiration?) . CXR: normal Lax and soft abdomen but with absent bowel sounds. CT Scan : CT scan was performed and showed a brain tumor with ventricular dilatation. Patient was referred to ACH. CT Scan THANK YOU : THANK YOU