History, Examinations & Notes.pdf
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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
-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
-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
Coverings of Testis:
1. Skin
2. Dartos muscle
3. Colle's fascia
4. External spermatic fascia
5. Cremasteric muscle & fascia
6. lnternal spermatic fascia
7. Tunica vaginalis (parietal & visceral layers).
8. Tunica albuginea (fibrous capsule).
#Surgery
1. Skin
2. Dartos muscle
3. Colle's fascia
4. External spermatic fascia
5. Cremasteric muscle & fascia
6. lnternal spermatic fascia
7. Tunica vaginalis (parietal & visceral layers).
8. Tunica albuginea (fibrous capsule).
#Surgery
Remember:
-Testicular nerves develop from T10-T12 ,so testicular pain may be felt around the umbilicus.
#Surgery
-Testicular nerves develop from T10-T12 ,so testicular pain may be felt around the umbilicus.
#Surgery
Nerve Suoply of GB:
1)Autonomic:-
Parasympathetic: hepatic branch of anterior vagus.
Sympathetic: from T7-9 (pain is reffered to inferior angle of right scapula).
2)Sensory:
-By the Right phrenic C3,4,5 (the same segments as the supra-clavicular nerves ) so pain in gall bladder is referred to right shoulder).
#Surgery
1)Autonomic:-
Parasympathetic: hepatic branch of anterior vagus.
Sympathetic: from T7-9 (pain is reffered to inferior angle of right scapula).
2)Sensory:
-By the Right phrenic C3,4,5 (the same segments as the supra-clavicular nerves ) so pain in gall bladder is referred to right shoulder).
#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
-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
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.
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.
-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.
After local examination of the breast, look for:
-If LN's are enlarged, examine the upper limb for edema, comparing it with the other.
Then to systemic examination: "mets."
-Abdomen for hepatomegaly and free fluid.
-Per-vaginal and per-rectal exam.
-Chest for effusion and consolidation.
-Bony swellings and tenderness.
-If LN's are enlarged, examine the upper limb for edema, comparing it with the other.
Then to systemic examination: "mets."
-Abdomen for hepatomegaly and free fluid.
-Per-vaginal and per-rectal exam.
-Chest for effusion and consolidation.
-Bony swellings and tenderness.
What are the differential diagnoses of Undescended Testis?
1-Ectopic testis:
-On raising the legs, ectopic testis in superficial inguinal pouch becomes more prominent but not is case of undescended testis located in inguinal canal.
-Simply during contraction of EO muscle, the ectopic testis will be more prominent because it's superficial to muscle, but undescended testis will be less or not appear because it's deep to the muscle.
2-RETRACTILE TESTIS:
-Here everything is normal, but there is overaction of cremaster.
-Testis is pulled up, to stay near the external ring and often mistaken for undescended testis.
-To differentiate by Orr chair test or squatting position, ask the child to sit on chair and see the testis, if it's descended to the scrotum, then it's retractile because of increased IP pressure, if not, it's undescended testis.
-Also retractile can be pulled down to its scrotum, but undescended can not because of short blood vessels.
-In warm condition, can be returned to its position.
3-Agenesis of testis which is called Anorchism.
Here no testis, so use US or CT.
4-Atrophy of testis:
-Hx of infection such as mumps.
5-Hermaphroditism:
-If bilateral, this should be excluded.
6-Other causes of groin swelling: lymph nodes, soft tissues, hernia, etc.
#Surgery
1-Ectopic testis:
-On raising the legs, ectopic testis in superficial inguinal pouch becomes more prominent but not is case of undescended testis located in inguinal canal.
-Simply during contraction of EO muscle, the ectopic testis will be more prominent because it's superficial to muscle, but undescended testis will be less or not appear because it's deep to the muscle.
2-RETRACTILE TESTIS:
-Here everything is normal, but there is overaction of cremaster.
-Testis is pulled up, to stay near the external ring and often mistaken for undescended testis.
-To differentiate by Orr chair test or squatting position, ask the child to sit on chair and see the testis, if it's descended to the scrotum, then it's retractile because of increased IP pressure, if not, it's undescended testis.
-Also retractile can be pulled down to its scrotum, but undescended can not because of short blood vessels.
-In warm condition, can be returned to its position.
3-Agenesis of testis which is called Anorchism.
Here no testis, so use US or CT.
4-Atrophy of testis:
-Hx of infection such as mumps.
5-Hermaphroditism:
-If bilateral, this should be excluded.
6-Other causes of groin swelling: lymph nodes, soft tissues, hernia, etc.
#Surgery
Forwarded from Quick Notes
Forwarded from Quick Notes
Forwarded from Quick Notes