Sh oc k

Swe llin g
-...,.,,

© Copyright 2017 by Mohammed EI-Matary

All rights reserved . No part of this book may be used or reproduced in any
manner whatsoever without written permission, except in the case of brief
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necessary arrangements at the first opportunity.

1st Edition 2017

.....,,
For further Information, visit our web site:
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Pref ace .._,

.........

This book provides an update for medical students who ~

need to keep abrea st of recent developments. I hope also it _
will be useful for those preparing for postgraduate '-./
examination .
'1........1

This book is designed to provide a concise summ ary of '-'

breast , endocrine surgery, general surge ry & vascu lar -----
surgery, in form of slides , jars, specim ens & radiographs . _,,

The autho r is extrem ely grateful to all the -

contributors for the high standard of the new chapters, and . J
hopes that you, the reader, will enjoy going through these '-..,/
pages as much as he had .

M. El-M atary .._/

,.__,

'-"

'-
\....-,

Acknowledgement
The author wishes to acknowledge with gratitude:

Dr. Mohamed Mohy

Cairo University

Dr. Kareem Mohamed

\......,
Ain shams university

.......
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..._,

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Mohamed EI-Matary
> IU6u/J'UI <
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{

Atlas of General Surgery

Hematoma Stretching of the scar

Hypertrophic scar Lacerated wound

1
 -1
- - - )
_ _Mohamed E! -Mat~ry Atlas of General Su_
rge
_ ry..__ _
Blood Clot

llt mos1~h 11nd C'ou i:uilllion

Ck:iin lf'IC' •IOO EJ\rfy c:.•,hJTO "H,l t lno" sc.i,r

Scab
Primary intention Fibroblast

Macrophage

Blood Vessel

Gaping wound Gran"latlOl'I 1.uue Large scar Fibroblast --- --------

l'rulirl'I .Ilion :.111d Oll!!f-1111111
W•lh blood Clo! ,.,,, in wound Proliforn1ing - - ·~

Secondary intention

Freshly healed epidermis

Freshly healed dennis

Cot\tamnah~ wounct Gmnu'afl0(1 t155oe Clos.Jre wtti

wide scar Wound healing process
Tertiary intention

2
Mohamed EI-Matary - - - -~ Atlas of General Surgery
- ~~~~~~--

Wound contracture Healing by 1ry intension

Bite wound Missile wounds

3
L___
Mohamed EI-Mata ry
- Atlas of General Surgery

Hematoma Healing by 1ry intension

4
Penetrating wounds Lacerated wounds

4
Mohamed EI-Matary --------- Atlas of General Surgery
~- ~~

Healing by secondary intension Wound failure (wound dehiscence)

5
.____ Mohamed EI-M atar y
~---~----------------
-Atla s of General Surg ery

THE WOUND TREATMENT SYSTEM

MOIST WOUND
Mad.ala Drainage

wnW OUN D
H«JY)'Droinage

c.,,,.....,
M.Adot.-"

.....
DRY MOIST
(A,Jd Moi1MoJ WET
(ldeo/)
flt•- Moit111t• )
 C
_ _ Mohamed EI-Mata"l _ _ _Atlas of General Surgery_

Absorbable Sutures Non-absarbable Sutures.

Polyglactin Polypropyk?ne

Polyglactln Fas-t
L Nylon/Polyamldo

Polygly<:oli-c Add Silk

Catgut Chromic
\_, / ' Polyester
l~
Poliglecaprone
\._/°' S1eel
C
Polydloxanone

7
Mohamed EI-Matary Atlas of General Surgery

2 J lrovnp J

Primary Survey

Assessment
Breat hing
• Patency
• Potential difficulty i!lc::c::.c::
Circu lation

Management
• Air ontty, uachoa
• Oxygenati on Q.c::c::.c Disab ility
• Ventilation • Level of consciousness
• 02
• Basic manot.cvr cs • Skin colour/temperature Assessment
• Definilive airway Management • Haemodyn amics • GCS
• 07. • Haemorrhage - external,' • Pupils
• Decompression concoalod • Deficits
• Venliliilory support
Management Management
• Control haemorrha ge
• Prevent s~ondary injury
• l{estore volume

[ 8
( ., - ~ -- - r
Mohamed EI-Matary _Atlas of General Surgery

Secondary Survey
1. Head
2. Neck.,._
- ______,.
3. Shoulders
4. Chest

~ 6. Abdomen

7. Pelvis Lower
5. Upper Limbs
Back
8. Lower Limbs

Sequence ofexamination.
L9J
Mohamed EI-Matary Atlas of General Surge ry
Normal range Causes of elevation Causes of decline
Sodium (Na): Hypernatremia: Excessive loss of Hypona tremia : Congestive heart failure, cirrhosis,
135-1 45 mEq/L ·uater through GI system, lungs, or nephrosis, excess fluid intake, syndro me of
skin: fluid restriction, certain diuretics, inappropriate antidiuretic hormone secretion
hypertonic IV solutions, tube feeding: (dilutional hyponatremia); sodium depletion, loss of
hypothalamic lesions, body fluids w ithout replacement, diuretic therapy,
hyperal dostero nism, cortico steroid laxatives, nasoga stric suctioning,
use, Cushing's syndro me, diabetes hypoaldosteronism, cerebral salt-wasting disease
insipidu s

Potassium (K): Hyperkalem ia: Aldosterone
3 .5 - 5.0 mEq/L deficiency, sodium depletio n,
acidosis, trauma , hemolysis of red
blood cells, potassium -sparing
diuretics
Calcium (Ca): Hypercalcemia: Excessive vitamin D, Hypocalcemia: Hypop arathyroidism ,
8.5 - 10.5 mg/dl immobility, hyperparathyroidism,
potassi um-sparing diuretics, ACE
inhibitors, malignancy of bone or
blood
Magnesium (Mg): Hypermagnesemia: Excessive use
1.5 - 2.5 mgi dl of magne sium-containing antacids
and laxatives, untreated diabeti c
ketoaci dosis, excessive magnesium
infusions
Hypokalemia: Lack of dietary intake of potassium,
vomiting, nasogastric suctioning, potassium-
depleting diuretics, aldosteronism, salt-wasting
kidney disease, major GI surgery, diuretic therapy
'Nith inadequate potassi um replace ment
malabsorption , insufficient or inactivated vitamin D
or inadeq uate intake of calcium, hypoalbuminemia,
diuretic therapy, diarrhea, acute panc reatitis, bone
cancer, gastric surgery
Hypomagnesemia: rvlalabs orption related to GI
disease, excessive loss of GI fluids, acute
alcoholism/cirrhosis, diuretic therapy, hyper- or
hypoth yroidism, pancreatitis, preeclamp.5ia,
nasogastric suctioning, fistula drainage

Electro lyte imbala nce

10
 ['['
Mohamed EI-Matary Atlas of General Surgery

2 ( 8/0(X/lro//s/vSiO// j ~
A antigen B antigen
/
' /
Blood type A Blood type B

AB antigen No antigens

Blood type AB Blood type 0

 )
Mohamed EI-Matary Atlas of General Surgery

TYPES OF SHOCK
Type of Shoc k Insult Phys iolog ic Comp ensa tion
Effec t
i
Cardioganlc Heart fails to pump blood out ,co BaroR c
•Ml, arrhyth mia, aortic stenosis,
t SVR
mitrol regUfg ,

Obstructive Heart pumps well, but the i CO BaroR c

outflON Is obstructed
t SVR
•Extroc ordioc obstru ctive causes
such as PE, tension
pneum othoro x, tompo node
Hypovolemlc Heart pumps well, but not t CO BaroRc
enough blood volume to pump 4
SVR
•Hemo rrhage
•Flud Loss (Vomiting, Diarrh ea,
BUfns}

Distributive Heart pumps well, but there is . SVR ♦ co

peripheral vasodi lation
•Se pie. a naphy lacttc, and
neurogenic shock
•Pancr eo tWs. burns, multi-t rauma
vkJ activa tion of the
inflam matory response

[ 12
 r ( r (
Mohamed EI-Matary Atlas of General Surgery

·················••4•··························································
•
............. •
•-•
•
.•• •
Pathogenesis of Septic Shock •••
••
•
~--··························· •••••••••••
Exotoxln -----~ •·············
.••..•.••..... : •

TSST-1
Toxin-A
Gut release of - - -
Nldus of Infection --+ Organism endotoxin
Abscess
Pneumonia lt ♦
Peritonitis Structural Component
Pyelonephritls Teichoic Acid Antigen
Cellulitis Peptidoglycan, Endotoxin (LPS)
Bacterial nucleic acids

Plasma
•
Monocyte-Macrophage Endothelial Cells Neutrophlls
! ~ ~
Complem~ins - Cytokines Selectins, lcams Lysosomes
• TNF Renin-angiotensin system Oxygen free radicals
Coagulation • Interleukins Prostaglandlns (superoxides)
- Extrinsic / intnnslc • Interferons Leukotrienes Granulocyte Colony
pathways · ~:Ga1 Prostacycfin Stimulating Factor
- Protein C: S · Thromboxane (G-CSF)
-TFPI Platelet Activating Factor Endothelin
Nitric Oxide
Tissue Factor 1
I ~(~ • ~- 1
,I
1
:LCellular Dysfunction J
I -

13
Mohamed EI-M atary )
Atlas of General Surge ry

Homor,ige Fluid
loss

_l
M yo<:,.)r dial
0< ~ lvulor
d1so.1s.c
A naphy tmos
N-our-< >gome
,mp~ts o&
l
Sops.is

Hypov olem,a - · Vosod1 la1.a1,o o

S YM PTOM S

t(
OFSH OCK
Sever e - - - ---+-- -~ - - D ocro:tS Od
hypoto nsion cord, ~
T output

Cold. cfll.mm y skin - - - -~ .._,,..._ _ H ypopo rfus,on

............: ' of tissuo
Edem 3 - Throm bos.s ~
H emorrh age
•!
Cell nnoxia <:

Sotnno loncc. coma _ I Shocl< I

"--. ,
OlJgun o -

Dyspn on I -
& ... - . ti ..
·
I A
.!
GI bleedi ng
P::ara.lytlc lieus
- --- --- --- ---11--- ---
Deat h due to
cnrdlo resixratory fn,luro

Patho genes is of hypov olemi c shock

14
 r· r c r r ·· C C CJ r .. ( ~ (
~! r·· [ · C' C
Mohamed EI-Matary Atlas of General Surgery

J Sur,icaliqfi,clio// I

Carbuncle Necrotizing fasciitis

Boil (Furuncle) Erysipelas

15
 I ) ) ) ) )
Mohamed EI-Ma tary Atlas of General Surge ry

Gas Gangr ene (Clost ridial myosi tis) Cellul itis

~~

Hydra denitis Suppu rativa Hydra denitis Suppu rativa

16
 Mohamed EI-Matary
C C C) Cl c--. c c r c c~
Atlas of General Surgery
r
- -

Erysipelas Spasm of the facial muscles (risussardonicus)

Gas gangrene Acute abscess

17
 ) )
--
Mohamed EI-Mata ry Atlas of General Surgery
--------------------
--~

Clostridi um tetani spores, magnifie d

Acute a bscess about 3,000 times their actual size

Mechanism ofAction of
Tetanus Toxin
( C. Mlonl ) Continuous

i·
c::J-C]
stimulation
by excitdory
transmitter
Tetonospasmin

\. T
• Inhibitory
tnhibito,y
transmitter
releose
lrontmftlr b&odcecf

[1~
 C r· ofccGeneral
c~Atlas r Surgery
c r- r
Mohamed EI-Matary

Risus Sardonicus in Tetanus patient

Neck rigidity & retraction

1i]
 1
Mohamed EI-M atary

> I Brwrsl I ~
Atlas of General Surg ery

- Polythelia
• Supernumery nipples
over breast
- Athelia
• No nipple over breast
(mainly acces sory
breast)
- Polymastia

C
·\ Ducts
• Accessory breast along
Lymph node• / / Nlpplo
milk ridge
Lymph vessels - - Areola - Amastia
• No breast development
- Fat
- Ama zia
Mille ll1111
• Nipple developed, no
breast development

Anat omy of breast Congenital anomalies of breast

20
 CJ Cr C
Mohamed EI-Matary Atlas of General Surgery

Pumping of breast Breast hematoma

Breast abscess Breast cyst

21
Mohamed EI-Mata ry Atlas of General Surgery

Breast hematom a Duct ectasia

'!

•
••
•.
.
Breast hematom a Fibrocys tic disease of the breast

22 I
 C C c\ c CC c- r- r r c· r r c
Mohamed EI-Matary Atlas of General Surgery

Right breast ,
Breast Quadrants
I
I
and
I
I
I
Breast Cancers
50% : 15%
I
.,-l.,
I \
,' 18%\
I I
----------:
1 t.
: -----------
I
I I
I I
\ I
11% ',..,./ 6%
I
'II
I
I

MRI showing cancer breast

23
 )
Mohamed EI-M atary
Atlas of General Surg ery

Adva nced canc er brea st

Cyst osarc omap hyloi d
Invasive ductal carcinoma Invasive lobular carcinoma
lloffNII d u:t

O~cta

OC:lll lob•um,1
<'.',o h

\__ "'Du ct
"-Lobule
Duct al carci noma in situ

2~
 r ( c-·
Mohamed EI-Matary Atlas of General Surgery

Normal Lobule Lobular carcltw·na

ln Situ
Skin dimpling

Advanced cancer breast

25
 ) r 1 C; ~) - ) T;(' j () C)
'
Mohamed EI-Ma tary
Nipple retrac tion
Cystys arcom aphyll oid
) rl r)
) { ) r')
Atlas of General Surge ry
Large breast cyst
Advan ced cance r breast
26
 (_ C C ( cc c· c
Mohamed EI-Matary Atlas of General Surgery

Paget disease Peau d' orange

◄-. ~ j ! .

True cut needle

27
 ') r ) ) r ) r )
Mohamed EI-Mata ry Atlas of General Surgery

Breast changes

Skin dimpling Modified radical mastecto my

Sentinel L.N. in conserva tive

mastecto my
C" c·-- c-, c·· r · c- c·, C C C r r" r · r · r _
Atlas of General Surgery
Mohamed EI-Matary

Male cancer breast

Bleeding per nipple Benign breast mass

29
"J ) ( 1 r ) i--) ) ) ) ) ) )
Mohamed EI - Matary Atlas of General Surgery

MANCHESTER SYSTEM
• Confined to breast only
STAGE 1 • mobile tumour less than 5cm in diameter
with or without local skin Involvement

• tumour confined to breast

STAGE 2 • nodes thought to be involved bul not fixed
- palpable, mobile and lpsllateral

• loc.allyadvclnccd di.s.ca~ It, brn.bl or nodes

• 1t,,-.,our we»I er I h,Ul .,Lnl u ~ IIIPtf'r with lnvulvp,n•w ,,I or
STAGE 3 • undctlyln i muse,c or
• skin w ,de of the tumour or
_ , , • axlll.iry node tix.itlon

STAGE 4 •distant metastases other than the

axillary nodes or
•satelnte nodules on breast or
•supraclavicular nodal involve ment

30
( c c <
1'\ohamea EI-MaTary
c r c~ c r- c-
- · C C C C (_
A t ~as b, ~~ne~al ~ur~er/
Breast self-examination
-

- © Gently squoozo
each mpplo and
look for discharge.

RatSC one arm.

@ Usmg one or
more of the methods
befow press frm'Y. \'ml
your flnge,~ and reel ReP.E?at this step
e1ound the entire
breast a, ea ror lurnps
(j) while lymg on
your back. Put the
, i \ Stand in front of Of thtekening. hand of the side you
\.!I a mirror wrth your @ Clasp hands
behind your @ Contmue
checking e~ you want to examine
arms relaxed .it your head. press hands
side~. Look fOf f«word and look fof
chang~ n lhe breasts any changes in Lh&
~ess your hancb
firmly on your hips,
hunch your shoulders
® Re peal this stCf>
m the shower',
often easier to fmd
It s
behind your head.
nauon the breos1by
ploc,ng o folded towel
$uch as swelling shopo or contour of ond Icon ro,word lum1>5 when your skm undcmcaUl tho samo
dUTtphng. Of pucl<~nng the breasts. sbghUy. is slick and soapy. shoulder.
or thesltin

Choose a
. . ,,,
method
roeow one or more or
these patterns when
conducting a breast
~elf•exam1notson Pay
(® ..
.,
.f'
'• C-++-
Yt~ ·
attention to the area Lines Clrdts Wtdaes
between the breast and Start in underarm areo Slowly 8eg1fl at outer edge of breast. Start at outer edge of breast.
undernrm, and 10 the move fingers downward until Move fingers slowly around Move fingers toward mpple.
undernrrn itSelf. Check they are below the breast. whole breast 111 a cl"cle. Work then back to edge Check
above breast. up lo move slightly toward the Ul 1ncrc~ngly smoHer circles whole breast. covering one
collarbone :md all tho
way ovc, to shoulder.
I middle and move back up.
Repeat over whote breast. I unb.l reaching nipple. smell wedge-shaped s«tton
ot o tune.

31
 1 )c') ' ) O r 1 u
Atlas of General Surger y

f Tfuroio',taqo' I ~

Lingual thyroid Diffuse hyperp lastic goitre

Thyrog lossal fistula Colloid goiter

32
 C [ r- r r - ~ _
Atlas of General Surgery
Mohamed EI-Matary

Thyroglossal cyst

Thyrotoxic goiter Huge multinodular goiter

I 33 J
n 1... --Mona' med ) - ) I C> r ) ) ) , ' •) • ) • ) •1 • )
t:1-Matary . "- -
r ) •

Atlas of General Surg ery

Cold nodu le in Rt thyro id gland in isoto pe scan

Infec ted thyro gloss al cyst

Cold nodu le in Rt thyro id gland in isoto pe scan Toxic nodu le in left thyro id gland uppe r pole

34
 t
I)
f'
:,
'1)
ci
L
I)
C
I)
\..... \!) ••., E
'4-- LU
0
~
-:.=
<
Lt)
("")
Q,)
"'
(,J
~ t
C,

Q,)
·-"C"'
'E
~
I
"'>
Q,)
w E
(!)
"'tJ
I)
e
C,
.s=
0
~
 .. ) ) r , l ; tJ (.._)
r ) 1)
Mohamed EI-Matary Atlas of General Surgery

1. Rosenbach's sign:
Tremors on closing eye lids.

2. Stellwag's sign :
Staring look with infrequent blinking.

3. Dalrymple's sign :
rim of sclera is seen between
cornea and the upper lid.

4. Von Graefs sign :

Lagging of the upper eye lid

5. Joffroy's sign :
loss of forehead corrugation when looking up

6. Moebius' sign :
Lack of convergence (due to ocular myopat hy )

Certain eye signs

Q6
 ( [ (
Mohamed EI-Matary Atlas of Gener al Surgery

2 J :lr krialsysleR/ J ~

Acute ischemia of lower limb

It

IEmbolus at bifurcation of the artery I Coloured arterial duplex

37 J
J }') " ) "') )..__1 ")
Mohamed EI-Ma tary Atlas of General Surge ry

Phelgm asia cerula dolens Acute upper limb ischem ia

--..- - ---~- pQIJoY ; p4lin

pol«r

I
pArtAl,si.s
po. t"e.sf hes i~s

Acute upper limb ischem ia post

intra arteria l drug injecti on Featur es of upper limb ischem ia

38
 C C r
Mohamed EI- Matary Atlas of General Surgery

CT angiography of lower limb CT angiography of lower limb

showing stenosis at popliteal A.

I
Endartertectomy of post.tibial A. I
Q9
 ')
Mohamed EI-Ma tary Atlas of General Surge ry
Wore Suro-, Afl•Surve r,

.........
~
lharldc
~

Monnll
ttfle'"'

Duple x scan AAA and repair

·'-
.·
-.u11 - --
f ~
A 8

Aortic dissec tion

,,.,. , ....
, ...
,
40
 [ C r
Mohamed EI-Matary Atlas of General Surgery

Congenital AV fistula AV fistula

Arteriovenous Fistula Arteriovenous Graft

From
dialysis
machine
~ .

graft Artery

To

j_JJ 41
Vein
) 1 J l, )7 }-----r } ' ) 1 ) ) ) C) <-) r _) CJ CJ CJ CJ
Mohamed EI-M atar y
Atla s of General Surg ery

Pop litea l arte ry con tusi on

Patc h ang iopla sty

J
Femoral :· ,ti
Arte rial bypa ss graf ting arte ry

Blo c~g c • j
1f( Pophteal \ -
,:,;J artery j

42 I
r · r ' r-· C' r , r ( ( C ' T - -

Atlas of General Surgery

r T

Mohamed EI-Matary

CkBak1.:y ( (I 111

StanfQrd_ .\ 1.3
Types of arterial aneurysms

- Blood fli
EVAR for abdominal aortic aneurysm
_.,, Tear n
· Inner layer

I Arterial dissection ,~~;- .--,

0~$0C1,

43
 '\ • ' r ) r" ") , ' • _) J')(J LJ
Mohamed EI-Mat ary Atlas of General Surger y

Mass..,

Arterio - venous fistula

Infecte d diabeti c foot gangre ne DRY gangre ne of lower limb

44
C - -
Mohamed EI-Matary
- C C c. [ [ [ ( ( l
Atlas ot General Surgery
( {

Dry gangrene of upper limb

Diabetic foot infection Raynaud's disease

45
 . ) , I
Mohamed EI-M atary .

Atlas of General Surge ry

Rem LC
I
)~~, '"'Crtr!nl &nay

Subc lavian steal syndr ome

,rterial
,Emergency

FOGARTY cathe ter Acute lower limb ische mia

46
tvn&...el c1 C. Jc£ ...rf ( ~ (_. ti( ... o\ Gl. .e{,_, S...,•g\.. y
r

~
[ Left common iliac occlusion Caludication pain in chronic ischemia

Critical lower limb ischemia Rest pain in chronic ischemia

47
 ) _) ' ' ) ~ J j
Mohatned dl-n\ata ry Atlas ot General Surgery

Burger disease Capillary refill time - ~

Ballon Angiopla sty

48
 ( .( cr c ( , ( ( l
Atlas of General ~urge ry
Mohamed EI-Ma tary

Rayna ud's diseas e I Magne tic resona nce Angio graph y I

49
.Ao,.cim"'d t...11..J to, y ) )
Atlas of General Su rge ry

Dia bet ic foo t ulc er

Ba llon ang iop las ty

50
Mohamed EI-Ma tary Atlas of General Surge ry

f1/eqousqsle/J/J ~
••: ----._
••• - *_ O 0O

Plate~ ~
Activat ed Platele ts
Change s In red blood
cell membr ane

Neutro phll •• Red blood cells

vesse l
c~ x~ x~ x- .:x x~ x~ :>

..
Fibrin Format ion
0 00
Platele ts 0 OO, _ -~.~~
0 ~ f '"":~
f"-,;.

TF Blood clot activat ion

Red blood
cells
TF
7 Blood

Thromb omodu lin

Activat ed Endoth elium
~
~

Patho genes is of DVT

51
 ' ) ) )
Mohamed EI-M atar y
Atla s of General Sur gery

s,.. (ll1 1oy Sku, Ch;l n~uti:

Ven ous insu ffici enc y

Ven ous gan gren e

Blo od vessels
Ven ous dup lex
Phe lgm asia ceru la dole ns

s2 I
 ( r ( C. C C c r r ( (
Mohamed EI-Matary Atlas of General Surgery

Venous duplex

· , Blood flow
~__ Closed
I val-.·c-
Varicose
•,e1ns

I.

CT venography
Vannco;em Open

l nvalve

53
 ) -l , ) "). \.' ...·1
Mohamed EI-Matary Atlas of General Surgery

Varicose veins and venous ulcer

MRV (magnetic resonance venography)

54
( CJ CJ C ( CJ Cl C C (

Mohamed EI-Matary Atlas of General Surgery

v.v. Injection of W

Venous ulcer

55
 ) ) ) j ) "l r J C)
Mohamed EI-Matary Atlas of General Surgery

v.v.

Superficial thrombophlebitis Venous gangrene

56
 ( C ( ( ( ., ( ( (

Mohamed EI-Mat ary Atlas of General Surger y

Varicos e veins

,.,..ol
In~

8'Ape11icllll OeepVWI
~.. Tiwo,nbo,il s

57
 ) ) -J J C) ·:J : J . )
Mohamed EI-M atary
---- - Atla s of General Surg ery

DVT Supe rficia l throm boph lebit is

Greenfield Filter
;,,
Inferior Vena Cuva

,....
Veno us ulce r ....
lnh:n•lf
I =:~;i~n
,_,,,,_ I

58
 r) c r ( ( '' ( " ( " ( '\ f
Atlas of General Surgery
Mohamed EI-Matary

2 {lfRIPftulic syslent J ~
.....
~

$,,
"

I I
I l l
stage I stage It stage Ill stage iv
Lymphoma stages

Chronic lymphatic obstruction

(Lymphedema)

Pathology of lymphoma I
59
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Mohamed EI-Mat ary Atlas of General Surger y

Acute Septic Lympha denitis

T.B Lympha denitis

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Face IT

Cleft lip "Hare lip"

Cleft Palate

64
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At1as of &ene ral ;:,urgery

Le Fort II Le Fort Ill

Le Fort I
f I

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Le fort class ificat ion of fract ure maxi lla

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Can cer max illar y sinu s

Cle ft palate

Can cer lip

66
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Frac ture nasa l bone s Subl ingua l derm oid cyst

[ Seba ceou s cyst I [ Dang erous area of the face

67
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Muc ous rete ntio n

Mac rogl ossi a

Ton gue tie

68
Mohamed EI-Mata ry Atlas of General Surgery

Ranula Macroglo ssia

Dental ulcer

69
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Chroni c superfi cial glossit is Cancer tongue

Fibrous epulis Cancer tongue

70
 Mohamed EI-Mata ry- Atlas of General Surgery
.____ --

Fibrous epilus Cancer cheek

Granulom atous epulis Mucous retention cyst

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Myeloid epulis Carcinom atous epulis

Adaman tinoma "Eve's tumor/Am eloblasto ma'

72
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Atlas of General Surg ery

Mohamed EI-M atary

Syp hilis

I A-Ulcerated chanc.re I
B-Ulcerated mucous
patches (snail track ulcers
IC-Gummatous ulcer I

Tub ercu losis of the tong ue

73
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Dent igero us cyst

Dent al cyst

74

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Dental cyst Heman giomat ous epulis

Maligna nt tongue ulcer

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Plun ging ranu la

76
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Mohamed EI-Ma tary Atlas of General Surge ry

2 '17/Yfl/0.f/dS I ~

Paroti itis Saliva ry fistula

[ Sialog ram showi ng stone in duct Paroti d tumor

77
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Snow storm in chro nic paro titis

Subl ingua l gland stone J

Paro tid absc ess

Paro tid tumo r
78
 Atlas OT l eneral :,urgery

Subm andibu lar sialog raphy Subm andibu lar stone

Paroti d adeno carcin oma

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Sj<> g!"e n • s Dry eyes .
. / dGm <1~ -to
tc from e ./'\.. eye surf ace.

Dry mou1"h.
- - - . : incr ease d
..._ e_:::::: 1"oo1'h deca y

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Sjogr en synd rome

Beni gn lymp hoep itheli al lesio nbbe nign lymp hoep itheli al lesio
n ( histo logy)
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Mohamed EI-M atary

)
Siala deniti s (benig n lymph oepith elial lesion assoc iated with sjogr en

Frey syndr ome

81
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Atlas of General Surg ery
---1

SU PE RF ICI AL PU LP SP AC E OF
t - - -_ __ _ _ F_IN
_ ~ _R_
S _ _ _ ___-
Eac h pul p spa ce fille d wi~ f~t is
sub div ided by the pre sen ce of
num ero us sep ta

• Thr oug h pul p spa ce run s the

term inal bra nch of the digi tal
pef'Os\0\)11'
arte ry tha t sup plyi ng the
diap hys is of the term inal 1

pha lanx .
.ff'..,., ~•ce
9
1,n1oUs i;e?\

The epip hys is of the dist al

pha lanx rece ives its blo od
sup ply pro xim al to the pul p

82
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Midpalmar
space
Hypothenar
space 1 Anato my of hand

Parona's
apace

Acute paron ychia

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Thena r space infection

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Kanavel's cardinal sign
• Tenderness over & limited to the flexor sheath
• Symmetrical enlargement of the digit ("fusifo rm")
• Severe pain on passive extension of the finger( > proximally)
• Flexed postur e of the involved digit

84
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Thenar space infection Acute Tenosynovitis "Most serious hand infection

~-

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Mid palmar space infection Thenar space infection

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Dupuytre n's contract ure

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Simple ganglion

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Prepotellor
Bursi tis

Volkmann's lschemic Contracture I Prepatellar bursitis

[ lngroing toenail

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Pulley _ _ _ _

Tendon
nodule

An inflamed nodule on the flexor

tendon catches at the pulley, temporarily
locking the finger in the flexed position.

Trigger finger
 ( ( l - l (
Atlas of General surge ry
Mohamed EI-M atary

Soft tissue sarco ma Acute paron ichya

Then ar space infect ion I Volkm ann's lsche mic Contr actur e I
89
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Mohamed EI-M atary
Atlas of General Surg ery

Carp al tunn el $ Web space infec tion

Parona spac e infec tion

Pulp spac e infec tion

90
 Atlas ·of General Surge ry

TI o.rfll/ I <
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Port wine stain, Nevus flamm eus l

Straw berry angiom a

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Atlas of General Surgery

AV malformation Lipoma

92
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Mohamed EI - Matary Atlas of General Surgery

Surgical removal of lipoma Dermoid cyst

Molluscumsebaceum (Keratoacanthoma)

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Callosity

Melanoma

94
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Sebaceous cyst

Papilloma

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Cercoid aneurysm

Melanoma

96
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Mohamed EI-Mata ry Atlas of General Surgery

Sequest ration dermoid cycts

Teratoma tous dermoid Implanta tion dermoid

97
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SURG ICAL INST RUME NTS

SURG ICAL ANAT OMY

SURG ICAL JARS

CASES

TRUE OR FALSE