Dr Tayyab Riaz Ch

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Dr Tayyab Riaz Ch

𝗔𝘀𝘀𝗶𝘀𝘁𝗮𝗻𝘁 𝗣𝗿𝗼𝗳𝗲𝘀𝘀𝗼𝗿
Consultant General & Laparoscopic Surgeon
"We Treat the Patient not the Disease"

02/08/2026

𝗛𝗼𝘄 𝘁𝗼 𝗨𝗻𝗰𝗹𝗼𝗴 𝗮 𝗙𝗲𝗲𝗱𝗶𝗻𝗴 𝗧𝘂𝗯𝗲 – 𝗦𝘁𝗲𝗽 𝗯𝘆 𝗦𝘁𝗲𝗽
A blocked feeding tube is a common problem, but most occlusions can be managed safely without immediate tube replacement when approached systematically.

𝗖𝗼𝗺𝗺𝗼𝗻 𝗖𝗮𝘂𝘀𝗲𝘀 𝗼𝗳 𝗧𝘂𝗯𝗲 𝗕𝗹𝗼𝗰𝗸𝗮𝗴𝗲
• Inadequate flushing before and after feeds or medications.
• Crushed tablets or poorly dissolved medications.
• Thick enteral feeds or feed residue.
• Mixing medications directly with feeds.
• Delayed flushing after interruption of feeding.
• Kinking or compression of the tube.

𝗦𝘁𝗲𝗽𝘄𝗶𝘀𝗲 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁
1️⃣ Warm saline drops to soften the blockage.
2️⃣ Gently flush with warm saline using a push-pause technique (never force).
3️⃣ Consider fizzy drinks in selected cases (evidence is limited).
4️⃣ Use a mixture of sodium bicarbonate and pancreatic enzyme for stubborn feed-related clogs.
5️⃣ Mechanical de-clogging devices, where available.
6️⃣ Replace the feeding tube if the tract is mature and the blockage cannot be cleared.
⚠️ Important: Never use excessive pressure to clear an obstruction, as it may rupture the tube or damage the feeding tract

𝗛𝗼𝘄 𝘁𝗼 𝗣𝗿𝗲𝘃𝗲𝗻𝘁 𝗕𝗹𝗼𝗰𝗸𝗮𝗴𝗲
✅ Flush with 20–30 mL water before and after feeds and each medication (unless fluid restriction applies).
✅ Administer medications separately—avoid mixing drugs with enteral feeds.
✅ Use liquid formulations whenever possible.
✅ Crush only medications that are safe to crush and dissolve them completely.
✅ Flush the tube regularly during continuous feeding.
✅ Avoid excessive force when resistance is encountered.

29/07/2026

𝗗𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗔𝗽𝗽𝗿𝗼𝗮𝗰𝗵𝗲𝘀 𝘁𝗼 𝗰𝗵𝗲𝗰𝗸 𝗳𝗼𝗿 𝗔𝗽𝗽𝗲𝗻𝗱𝗶𝗰𝗶𝘁𝗶𝘀 𝗶𝗻 𝗖𝗵𝗶𝗹𝗱𝗿𝗲𝗻
𝗧𝗵𝗲 𝘀𝘁𝗲𝘁𝗵𝗼𝘀𝗰𝗼𝗽𝗲 𝘁𝗲𝘀𝘁
It involves using the stethoscope diaphragm to press on the abdomen under the guise of listening for sounds, helping doctors distinguish true involuntary muscle guarding from exaggerated pain responses.
𝗧𝗵𝗲 𝗛𝗲𝗹𝗽𝗶𝗻𝗴 𝗛𝗮𝗻𝗱 𝗧𝗲𝘀𝘁
Screaming children, too young to co-operate in the search for physical signs, sometimes can be placated by the following expedient.
The abdomen is palpated with the child's own hand When the point of maximum tenderness is approached, the child pulls its hand away, and commences crying. This simple method, if carried out patiently, will often succeed in elucidating the area of maximum tenderness when other methods are inconclusive.
𝗣𝗮𝗹𝗽𝗮𝘁𝗶𝗼𝗻 𝘂𝗻𝗱𝗲𝗿 𝗦𝗲𝗱𝗮𝘁𝗶𝗼𝗻
If there is doubt even after stethoscope and Helping hand Tests, sedate the child and re-examine when he/she has fallen asleep. If there is an area of local tenderness due to peritonitis, the child will wake when this area is palpated
𝗖𝗧 𝘀𝗰𝗮𝗻 𝗮𝗯𝗱𝗼𝗺𝗲𝗻
The role of an abdominal CT scan in children with suspected acute appendicitis is to provide a highly accurate backup diagnosis when clinical exams and ultrasounds are unclear offering a sensitivity and specificity of around 94% to 95% to definitively confirm or rule out appendicitis.

27/07/2026

Healing isn't always about advanced technology—sometimes, it's about thoughtful innovation. 🤍
A simple saline-filled glove can provide gentle cushioning for vulnerable hands, helping redistribute pressure preventing pressure sores while offering a reassuring sensation of being held. For many critically ill patients, these small acts of care can make a meaningful difference in both physical comfort and emotional well-being.

26/07/2026

𝗧𝗵𝗲 𝗗𝘂𝗻𝗵𝗶𝗹𝗹 𝗼𝗽𝗲𝗿𝗮𝘁𝗶𝗼𝗻
The Dunhill operation (or Hartley-Dunhill procedure) is a specific type of thyroid surgery involving the removal of one entire thyroid lobe with the isthmus and a subtotal resection of the opposite lobe.
First described by Sir Thomas Peel Dunhill, this technique remains a great option in specific cases of bilateral benign multinodular goiter or asymmetrical disease.
👉🏻 The Technique: Total resection of one entire lobe and the isthmus, leaving a small (~2–4g) controlled remnant on the opposite side.
👉🏻 The Goal: Reduce the risk of permanent hypoparathyroidism and recurrent laryngeal nerve injury compared to a total thyroidectomy, while managing the dominant pathology.
👉🏻 Post op benefit: There remains no or lower need of lifelong thyroixine which is needed after total thyroidecyomy. thyroidectomy
👉🏻 Pearl: Meticulous capsular dissection and identification of the recurrent laryngeal nerve and parathyroids are still vital on the retained remnant side.

22/07/2026

𝗦𝗲𝗴𝗺𝗲𝗻𝘁𝗮𝗹 𝗖𝗼𝗹𝗲𝗰𝘁𝗼𝗺𝘆 𝗠𝗮𝗱𝗲 𝗦𝗶𝗺𝗽𝗹𝗲
Not every colon cancer requires the same operation.
The extent of bowel resection depends on:
✅ Tumor location
✅ Arterial blood supply
✅ Lymphatic drainage
✅ Oncological principles
This carousel summarizes the standard resections:
🔹 Ileocecectomy
🔹 Limited right colectomy
🔹 Right hemicolectomy
🔹 Extended right hemicolectomy
🔹 Transverse colectomy
🔹 Left hemicolectomy
🔹 Extended left hemicolectomy
🔹 Sigmoid colectomy
🔹 Subtotal colectomy
🔹 Total colectomy
🔹 Total proctocolectomy
Understanding which vessels to ligate is just as important as knowing which segment to remove.
📚 Save this post for quick revision. 👨‍⚕️ Share it with your colleagues and surgical residents.

18/07/2026

Not every red or blue swelling on the tongue is cancer. A tongue hemangioma is a benign blood vessel growth that may simply require observation—but if it bleeds repeatedly or affects speech or eating, treatment may be necessary. Early evaluation helps ensure the correct diagnosis and management.
Doppler USG and MRI can diagnose the lesion very well.
Biopsy is generally avoided unless the diagnosis is uncertain because of the risk of bleeding. If taking biopsy only take small chunk and put ice or advise icecream after biopsy for hemostasis - avoid stitching
Treatment options include:
Observation (small, asymptomatic lesions)
Laser therapy
Sclerotherapy (injecting a sclerosant to shrink the lesion)
Surgical excision for selected localized lesions
Medications (such as propranolol) are mainly used for problematic infantile hemangiomas, not most adult vascular lesions.

12/07/2026

𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝘆 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 𝗶𝘀𝗻'𝘁 𝗮 𝗼𝗻𝗲-𝘀𝗶𝘇𝗲-𝗳𝗶𝘁𝘀-𝗮𝗹𝗹 𝗽𝗿𝗼𝗰𝗲𝗱𝘂𝗿𝗲.
Every patient presents unique challenges—from obesity and previous abdominal surgeries to pregnancy and cirrhosis. Safe access, trocar placement, and surgical strategy must be adapted to each situation.
Swipe through to learn the key modifications every surgeon should know.
🩺 Tailor the technique. Maximize safety.

11/07/2026

Good judgment cornes from experience but experience comes from bad judgment _ John C. Maxwell

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