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.

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

Lipoma.

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Ulnar never.

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Apple core sign aka ( Eaten apple sign ) : cancer colon .

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Bird peak sign : Achalasia cardia .

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Triple bubble sign : Jejunal atresia.

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Double bubble sign : Duodenal atresia.

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Single bubble sign : Pyloric atresia.

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Types of Hernia.
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Distension of bowel in case of IO:
-By gas due to:
1- Swallowed air (70%),
2-From blood in the lumen (20%),
3-From bacterial action and digestion (10%); mainly N2 and H2S.


-Due to fluid mainly of digestive juices which normally get absorbed, but in obstruction absorption ceases and accumulated fluid causes bowel distension (1500 ml saliva, 2000 ml gastric juice, 1000 ml bile, 1500 ml pancreatic juice and 3000 ml from small intestine [succus entericus]); often oedematous bowel wall further secretes more fluid into the lumen aggravating the distension.

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Remember:

-Duration of double J is roughly frome 1.5 to 2 months, but the duration is variable according to the case.

-Suprapubic catheter should be inserted in full bladder not in empty bladder about finger to two finger bridths above the symphysis pubis  to avoid injury of other structures in empty bladder.


-Full bladder  is checked by percussion, aspiration and US.

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Remember:

Appendix:

•5–10 cm in size but can be variable. •Size of its lumen is that of matchstick.
•Diameter of appendix is 3–8 mm;
•Diameter of lumen is 1–3 mm (matchstick)..

-Blood supply is from appendicular artery, a branch of ileocolic artery, ileocolic artery is the lowest branch arising from the concavity of the superior mesenteric artery.
-SMA arises from the front of abdominal aorta at the level of lower border of L1.
-SMA supplies the midgut from the levelof ampulla of Vater till the right 2/3 of the transverse colon.

Branches:
1-lnferior pancreaticoduodenal artery.
2-Jeiunal & ileal branches (12- 15)
3-Right colic artery
4-Middle colic artery

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Remember:

-Widest portion of colon: Cecum

-Narrowest portion of colon: Sigmoid

-MC site of colonic rupture caused by distal obstruction: Cecum

-Colon absorbs water, NaClQ; secretes K+, HCO3 and mucus

-MC site of ischemic colitis: Splenic flexure.

Most Common Type of Stones.

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Types of IV fluid.

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History taking in anorectal diseases.

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History taking of anorectal disease.
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