Apparent leg length discrepancy:

-Measuring distance from the umbilicus or xiphisternal junction to the medial malleoli.

-Unequal distance signifies apparent leg length discrepancy, especially if there is not a true leg length discrepancy.

-It may be caused by pelvic obliquity or adduction or flexion deformity in the hip joint.

-Note:
It's performed after doing true leg length discrepancy.

#Surgery

What are indications of cholecystectomy in asymptomatic GB stone?

1-Patient is diabetic or immunosuppressed.Why?
It causes Emphysematous severe fulminant cholecystitis, that leads to gangrene, perforation and peritonitis.
2–High chances or risk of developing gallbladder carcinoma
3–Stone more than 2.5 cm/multiple stones
4–If gallbladder wall is thickened
5–Porcelain Gallbladder- Absolute indication for cholecystectomy! 10٪ will develop adenocarcinoma.

#Surgery

Liver can persist or live without hepatic artery i.e (presence of portal vein only) but if the liver is healthy.
➖➖
Qaudate lobe is the only lobe which does not drain its venous blood to hepatic vein
➖➖➖
We don't put tube in case of TB abscess or amoebic abscess because this procedure lead to formation of fistula .
➖➖➖
The commonest site for rupture of amebic abscess is the peritoneal cavity.


د ناجي حومش.

#Surgery

Three questions to ask patient in a short case history:

-What happened? "CC"
-When happened? "Duration"
-What is the current situation? "Complications, investigations, or ttt and surgery".

#Surgery

Summary of Hx:

-Age, gender,name, Important findings in personal history, Chief complaint, Analysis of chief complaint, Important findings in review of systems, with important negative findings!Important drugs,family and socioeconomic history, and your most probable diagnosis.

#Surgery

Kocher’s test:

-Slight push on lateral lobes will produce stridor in case of obstructed trachea. Because trachea is already compressed"Slit like"!
-It may be positive in large mass bilaterally.

#Surgery

Lahey’s method:

-To palpate right lobe push the right lobe with right hand to right side and palpate with left hand.

Crile’s method:

-Place the thumb on the thyroid while the patient swallows; this method is used to diagnose doubtful nodules.

#Surgery

Pizzilo’s method:

-In case of obese and short necked individuals.

-Ask the patient to keep the hands behind the head and ask to push head backwards against clasped hand on occiput.

#Surgery

Berry’s sign:

-Malignant thyroid engulfs the carotid sheath completely hence pulsation not felt.

#Surgery

History, Examinations & Notes how to read X-ray Orthopedics.pdf

Remember:

-Inferior epigastric artery arises from the external iliac artery.

-It anastomoses with the superior epigastric artery. 

#Surgery

Remember:

-Superior epigastric artery arises from the internal thoracic artery (referred to as the internal mammary artery ).

-The internal thoracic artery arises from the anterior surface of the subclavian artery near its origin.

#Surgery

Remember:

-Testicular nerves develop from T10-T12 ,so testicular pain may be felt around the umbilicus.

#Surgery

Remember:

-Hasselbach's triangle is also called triangle of Halshted, inguinal triangle.

#Surgery

What are the types of Direct inguinal hernia?

1-Medial
2-Lateral

#Surgery

Remember:

-The ilioinguinal nerve is a branch of the first lumbar nerve (L1)

-Innervates Skin over the root of the penis and upper part of the scrotum (male), skin covering the mons pubis and labium majus (female).

-Motor innervation of the transverse abdominus and obliques.

#Surgery

Remember:

-The Adductor canal is also called Hunter's canal or Sub-sartorial canal.

#Surgery

This is an example of a breast lump examination:

Local:
Inspection:

-Both breasts are symmetrical, there is no change in size, there is no changes in the nipples and areola such as crackles, eczema, retraction or discharge.
-There is no skin changes as redness, edema, dilated veins, puckering, nodules, ulceration, or fungation.
-There is no scars.
-There is a single swelling in the upper outer quadrant of the right breast, about 2×2 cm in size but I'll confirm during palpation, rounded, with smooth surface, , the skin over the swelling has no changes.

-Upon elevation of both arms, there is no dimpling, no visible swellings in both axillae.

Palpation:

-Both breasts are not hot or tender.
-By palpating the left breast, there is no palpable mass.
-By palpation of the right breast, there is a single swelling about 3×3 cm in the upper outer quadrant, rounded, with smooth surface and firm consistency, well-defined border, it's freely mobile, not attached to the skin or underlying structures.
-By squeezing the nipple, there is no discharge.

-By palpation of LN's, there is no palpable axillary or supraclavicular lymph nodes.