- Basic bony surface anatomy of the knee.

Basic bony surface anatomy of the knee.

- Bladder Injury.

Bladder Injury

Aetiology:-

1. Blunt trauma : 10% of pelvic fractures.
2. Penetrating trauma :gunshots or stap wounds.
3. Iatrogenic:-
• Obestetric :- 0.3% with caeserean section.
• Gynaecological e.g.during a vaginal or abdominal hysterectomy.
• Urological e.g during cystescopy.
• Orthopaedic e.g. pins and screws can commonly perforate the urinary bladder, particularly during internal fixation of pelvic fractures.
4. Idiopathic:- due to presence of a previous scar.

Classification(Pathophysiology):-

1. Extraperitoneal rupture bladder:
Usually due to fracture pelvis,and Extravasation occur at the perivesical space and may extend up to the anterior abdominal wall,If the urogenital membrane is injuried.
2. Intraperitoneal rupture bladder:(The most dangerous)
Usually due to direct trauma when the bladder is full,associated with electrolyte disturbance and may passed unnoticed for along time.

- Side effects of antithyroid drugs.

Side effects of antithyroid drugs.

"Charge"

Cholestatic jaundice.
Hypothyroidism.
Allergy,Agranulocytosis.
Relapse on sudden stoppage.
Goiter,Git upsets.
Exophthalmos increase.

enjoy,,

Dr Ibrahim

-Duhin-Johnson syndrome.

Duhin-Johnson syndrome.

It is Autosomal recessive disease characterized by Partial defect in excretion of conjugated bilirubin into the bile.

*Clinical picture:-It is usually asymptomatic.

1. Jaundice.
2. Good general condition.

*Investigations:-

1. Bilirubin: mild elevation of direct bilirubin
2. Biopsy (dark pigment inside hepatocytes i.e the liver is black in colour), it had been proved to be a metabolite of catecholamines.
3. +ve Bromosulphthalein (BSP) Test: Normally 90% of this dye is removed from blood within 45 minutes after I.V injection in normal liver.
In Dubin-Johnson syndrome there is a late rise in plasma SSP after an initial fall due to reflux of the dye from the liver reflecting hepatic excretion defect.
4. No evidence of obstruction.
5. No evidence of LCF.

*Treatment:-

No treatment (almost normal life span).

Dr Ibrahim

Return to list of medical syndromes here

- Classification of Graves' eye disease.

Classification of Graves' eye disease. 

"NO SPECS"

• Class 0: No signs or symptoms.
• Class 1: Only signs (limited to upper lid retraction and stare, with or without lid lag).
• Class 2: Soft tissue involvement (oedema of conjunctivae and lids, conjunctival injection, etc.).
• Class 3: Proptosis.
• Class 4: Extraocular muscle involvement.
• Class 5: Corneal involvement.
• Class 6: Sight loss (due to optic nerve involvement).

Enjoy,,

Dr Ibrahim

- Source:-

• Werner SC. Modification of the classification of the eye changes of Graves' disease: recommendations of the Ad Hoc Committee of the American Thyroid Association. J Clin Endocrinol Metab 1977;44: 203-4.