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🔰_Worrying featuresa ➫ Abdominal pain ➫ distension ➫ nausea/vomiting ➫ ↑HR, ↓BP ➫ absent/tinkling bowel sounds ➫ weight loss ➫ PR bleeding يعني اللي ممكن تخوف في الامساك هي الم في البطن, انتفاخ, غثيان او قيء, زيادة ضربات القلب, انخفاض ضغط الدم,  اختفاء او خشخشة لاصوات الامعاء, فقدان الوزن, نزيف شرجي.. 💐💐 ______ 🔰_Think about 🔸_serious  ➫bowel obstruction ➫bowel/ovarian cancer 🔸_common  ➫medications ➫poor diet ➫paralytic ileus ➫dehydration ➫functional disorders 🔸_other ➫anal fissure/stricture ➫pelvic mass ➫spinal injury ➫hypothyroid ( see table 9.9) في حالة الامساك لازم تفكر بـ_🔰 اولا ... تفكر في الخطير انسداد الامعاء سرطان الامعاء او المبايض  ثانيا.. الشائعه ادويه وسنذكرها لاحقا تغذيه سيئه شلل بالامعاء جفاف خلل وظيفي ثالثا... تفكر في المشاكل الاخرئ تشققات في الشرج او تضيقه وجود كتله (ورم) في الحوض اصابه في العمود الفقري يتبع..... .. 📙_الـــ مصدر  Oxford Handbook

Oedema 1 - Pitting oedema:   Fluid can either be squeezed out of the veins ( increased hydrostatic pressure , eg DVT , right heart failure ) or diffuse out because of reduced oncotic pressure ( low plasma proteins , eg cirrhosis , nephrotic syndrome , protein losing enteropathy ) leading to an osmotic gradient with the tissues . The cause of oedema is still not completely understood . ........................................................................................................................................... 2 - Periorbital oedema:   Oedema around the face has a very different differential;The eyelid skin is very thin so periorbital oedema is usually the first sign —think of  allergies ( contact dermatitis , eg from eye make-up , stings ), angioedema (can be hereditary), infection ( orbital cellulitis can be life threatening, refer to hospital immediately if concerned, other infections include EBV and sinusitis ); if there is propto

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