Remember:
-All causes of CKD cause anaemia Except polycystic kidney disease& Renal cell carcinoma which cause polycythemia due to excess erythropoietin secretion.
#Nephrology
-All causes of CKD cause anaemia Except polycystic kidney disease& Renal cell carcinoma which cause polycythemia due to excess erythropoietin secretion.
#Nephrology
Complications of Undescended Testis:
-Sterility.
-Trauma and pain.
-An associated indirect inguinal hernia (80%).
-Torsion testis.
-Epididymo-orchitis.
-Testicular atrophy.
-Malignant transformation.
-Psychological troubles.
#Surgery
-Sterility.
-Trauma and pain.
-An associated indirect inguinal hernia (80%).
-Torsion testis.
-Epididymo-orchitis.
-Testicular atrophy.
-Malignant transformation.
-Psychological troubles.
#Surgery
What is the Role of hormone therapy in undescended testis?
-Not much.
What is the indication?
-Only indications are cryptorchidism associated with hypogenitalism and obesity and doubtful retractile testis.
-It should be given at or after the age of eight.
#Surgery
-Not much.
What is the indication?
-Only indications are cryptorchidism associated with hypogenitalism and obesity and doubtful retractile testis.
-It should be given at or after the age of eight.
#Surgery
Nerve supply of Appendix:
- T10 supplies the peritoneal coverings of the appendix, so reffered appendicular pain is felt at the umbilicus.
#Surgery
- 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
- 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
-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
When to stop the drugs before surgery in thyroid operation?
If the patient is posted for surgery tomorrow morning
1.Stop carbimazole today night
2.Stop Lugol’s iodine today night
3.Propranolol to be given tomorrow morning also.
After surgery:
1.Stop carbimazole and Lugol’s iodine
2.Continue the propranolol for 7 days to handle the thyroxine released during surgery and to prevent peripheral T4 to T3 conversion.
#Surgery
If the patient is posted for surgery tomorrow morning
1.Stop carbimazole today night
2.Stop Lugol’s iodine today night
3.Propranolol to be given tomorrow morning also.
After surgery:
1.Stop carbimazole and Lugol’s iodine
2.Continue the propranolol for 7 days to handle the thyroxine released during surgery and to prevent peripheral T4 to T3 conversion.
#Surgery
What are the diagnostic points for lipoma?
1.Lobulation
2.Slip sign "slippery edge"
3.Soft swelling with pseudofluctuation
4.Transillumination positive if it is subcutaneous
5.The overlying skin may show prominent veins when the lesions are large.
#Surgery
1.Lobulation
2.Slip sign "slippery edge"
3.Soft swelling with pseudofluctuation
4.Transillumination positive if it is subcutaneous
5.The overlying skin may show prominent veins when the lesions are large.
#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.
#Surgery
-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.
#Surgery
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
-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
-This early intervention may permit post-natal germ cell development to proceed normally.
#Surgery
French gauge (Fg) is a commonly used measuring unit for the size of catheters, this was described by a french instrument maker "Charriere", and it is the measurement of the cross sectional circumference of a catheter, so a three french gauge roughly means 1 mm when measuring the diameter rather than circumference.
#Surgery
#Surgery
Quick Notes
Testicular torsion ◼️Predisposing factors include (1) Undescended testis, (2) Spiral arrangement of cremasteric muscle, (3) Inversion of the testis, this is the most common factor in which the testis lies transversely and thus easily torted, (4) High investment…
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
-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
-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
Quick Notes
Murphy's sign. This is the classical method. #Surgery
Methods to elicit MURPHY’S SIGN:
1)Patient in upright/sitting position, the right hand of the examiner curls up under the right costal margin (or extended fingers with moderate pressure) of the patient at the tip of the ninth rib and patient is requested to take a deep breath. If the gallbladder is inflamed, the patient will experience pain (winces with pain and catch the breath) as the gallbladder descends and contacts the palpating hand.
2)The extended and abducted left thumb is placed in right subcostal region without pressing deep; the patient is requested to take a deep breath.This is elicited in lying down supine position. Called Moynihan’s modification of eliciting Murphy’s sign.
3)Identify the right Midclavicular line then descend to the right costal margin and put your one or two fingers there, as that site is the anatomical position of GB fundus.
4)From linea semilunaris and ascend to right costal margin. This isn't good in obese patients.
5)A line from left ASIS to the umblicus and other from the umblicus to the right costal margin tip of 9th costal cartilage. It's called Grey Turner line.
6)From the RIF and ascend upward, this facilitates the detection if there is also hydropes of GB. د. رمزي
7)Sonographic Murphy’s sign is eliciting same sign using sonographic transducer. It is more sensitive and more accurate.
1)Patient in upright/sitting position, the right hand of the examiner curls up under the right costal margin (or extended fingers with moderate pressure) of the patient at the tip of the ninth rib and patient is requested to take a deep breath. If the gallbladder is inflamed, the patient will experience pain (winces with pain and catch the breath) as the gallbladder descends and contacts the palpating hand.
2)The extended and abducted left thumb is placed in right subcostal region without pressing deep; the patient is requested to take a deep breath.This is elicited in lying down supine position. Called Moynihan’s modification of eliciting Murphy’s sign.
3)Identify the right Midclavicular line then descend to the right costal margin and put your one or two fingers there, as that site is the anatomical position of GB fundus.
4)From linea semilunaris and ascend to right costal margin. This isn't good in obese patients.
5)A line from left ASIS to the umblicus and other from the umblicus to the right costal margin tip of 9th costal cartilage. It's called Grey Turner line.
6)From the RIF and ascend upward, this facilitates the detection if there is also hydropes of GB. د. رمزي
7)Sonographic Murphy’s sign is eliciting same sign using sonographic transducer. It is more sensitive and more accurate.
Quick Notes
Methods to elicit MURPHY’S SIGN: 1)Patient in upright/sitting position, the right hand of the examiner curls up under the right costal margin (or extended fingers with moderate pressure) of the patient at the tip of the ninth rib and patient is requested…
The sign is described by John murphy, a professor of surgery chicago USA.
Forwarded from Quick Notes
•Murphy's Triad:
-It is associated with acute appendicitis, a medical emergency which presents with:
1-Lower right abdominal pain
2-Nausea and vomiting
3-Fever.
•Murphy's sign:
-It is useful for differentiating pain in the right upper quadrant.
-Typically, it is positive in acute cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.
•Murphy's test
-It is a costovertebral angle (CVA) tenderness that results from touching the region inside of the costovertebral angle.
•Murphy's drip:
-It is a rectal infusion apparatus to administer the medical procedure of proctoclysis, also known as rectoclysis.
#Surgery
-It is associated with acute appendicitis, a medical emergency which presents with:
1-Lower right abdominal pain
2-Nausea and vomiting
3-Fever.
•Murphy's sign:
-It is useful for differentiating pain in the right upper quadrant.
-Typically, it is positive in acute cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.
•Murphy's test
-It is a costovertebral angle (CVA) tenderness that results from touching the region inside of the costovertebral angle.
•Murphy's drip:
-It is a rectal infusion apparatus to administer the medical procedure of proctoclysis, also known as rectoclysis.
#Surgery