Plain X-ray in Acute appendicitis:

May show the following:
-Lumbar scoliosis towards right due to psoas spasm which is not uncommon
-Faecolith on the right side;
-Obliteration of preperitoneal fat line due to retrocaecal appendicitis;
-Segmental ileus in caecum and terminal ileum
-Speckled extraluminal gas in right iliac fossa, gas in appendix,
-Pneumoperitoneum (very rare);
-Intestinal obstruction (occasionally only);
-Soft tissue mass in mass or abscess of appendix.

all these features are very much nonspecific. X-ray is useful to rule out DU perforation, intestinal obstruction, ureteric stone.

Also Radio-opaque appendix in a plain X-ray. It could be calcified or have calcified content.

د. فواز عمران يحب يسأل فيهن.

#Surgery

Differences between mass and abscess of appendix.

#Surgery

Some fractures the may heal without immobilization:

-Rib
-Scapula
-Clavicle.

#Surgery

Umblical and Para-umblical hernia.

-Imp.
#Surgery

Remember:

-All causes of CKD cause anaemia Except polycystic kidney disease& Renal cell carcinoma which cause polycythemia due to excess erythropoietin secretion.

#Nephrology

Nerve supply of Appendix:

- T10 supplies the peritoneal coverings of the appendix, so reffered appendicular pain is felt at the umbilicus.

#Surgery

Descent of the Testes:

- At the 6th month of the intrauterine life, they lie at the internal inguinal rings(common site for undescended testis).

- At 7th month they go through the inguinal canal.

-At 8th month they lie at the external inguinal rings or at the neck of scrotum.

-They descend to scrotum just before birth.

#Surgery

Remember:


-Malignant transformation in undescended testis is 20 times more common than normally descended testis.
-It is higher in abdominal than in inguinally located testis.
-Seminoma is the most common malignancy in undescended testis.
-The testis which has normally descended on other side testis (in case of unilateral undescended testis), is also more prone for malignant transformation than normal individual.

#Surgery

What is the commonest plane of lipoma?

-Subcutaneous (between the deep fascia and skin).

#Surgery

What is slip sign?

-If the edge of the lump is pressed, the swelling slips from beneath the finger.
-This can be easily demonstrated in the case of a subcutaneous lipoma and it is said to be pathognomonic.

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Associated Anomalies with undescended testis:

-Epididymal anomalies and patent processus vaginalis upto 90%.

-Renal Anomalies in10% cases (Renal hypoplasia, agenesis,horseshoe kidney, PUJ obstruction)

-Hypospadias.

#Surgery

-In most pediatric centers, orchiopexy for unilateral UDT is done when patient have reached about 6 months of age.

-This early intervention may permit post-natal germ cell development to proceed normally.

#Surgery

Differences between torsion testis and acute epididymo-orchitis.

#Surgery

To differentiate between testicular torsion and acute epididymo-orchitis:

-If pain is relieved by scrotal elevation, it is acute epididymo-orchitis.

-If pain is increased by scrotal elevation, then it's torsion. "Prehn's sign".


(Prehn’s sign):
Acute epididymo-orchitis—elevation of the scrotum for one hour, relieves the pain of acute epididymo-orchitis but aggravates in case of torsion testis.

#Surgery

-Portal vein consists of SMV and splenic vein.

-It begins behind the head of pancreas and in front of IVC, ends at porta
-hepatis.
-About 3inch length.
-About 0.8-1.2 cm diameter.


Direct tributaries:
Portal vein drains the whole. intra-abdominal alimentary tract and anterior abdominal wall:

- Left and right gastric veins.
-Small pancreatic & duodenal veins.
-Para-umbilical veins into left branch of portal vein.
- Splenic vein.
-SMV.
-Cystic vein.

Pressure: 10 - 20 cmH2O (7 - 11 mmHg).

#Surgery

Murphy's sign.
This is the classical method.

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