Important.

🔻Radiation of pain:
-It is the extension of the pain to another site while the initial pain persists.
-Radiating pain is of same character of original site.
-For example, penetration of duodenal ulcer posteriorly causes pain both in epigastrium and back.
-Pain of pancreatitis radiates to back.

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🔻Referred pain:
-It is pain that is felt at a distance from its source. It's not felt at the site of the disease.
-For example, inflammation of the diaphragm causes a pain experienced only at the tip of the shoulder.
-Hip joint pathology may cause referred pain in knee joint.
-Referred pain in the epigastrium from the heart; referred pain in the abdomen from pleura; referred pain over the testis from the ureter..etc
-Referred pain is caused by the inability of the central nervous system to distinguish between visceral and somatic sensory impulses.

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🔻Shifting/migration of pain:

-Origin of pain is in one site; later pain shifts to another site and pain at original site disappears.
-Pain when begins in viscera, is felt at the same somatic segmental area in the body; but once parietal layer is involved by inflammation/ pathology pain is felt at the anatomical site.
-Common example is that of acute appendicitis.

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Most common GB stone in 3rd world is mixed.

In Hydatid cyst:

Most common presenting symptoms: Abdominal pain, dyspepsia and vomiting.

MC sign: Hepatomegaly.

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Comparison between amebic and pyogenic liver abscess.

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Built of patient in a thyroid case:

•Thyrotoxicosis—thin and underweight
•Hypothyroidism—obese and overweight
•Carcinoma—anemia and cachexia
•Mask like facies—hypothyroidism.

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HYDRONEPHROSIS (HN)
-It is an aseptic dilatation of pelvicalyceal system due to partial or intermittent obstruction to the outflow of urine.

▪️Causes:
Unilateral
🔻A.Extramural:
1. Aberrant renal vessels (vein or artery). It is common on left side.
2. Compression by growth (carcinoma cervix, carcinoma rectum).
3. Retroperitoneal fibrosis.
4. Retrocaval ureter.

🔻B. Intramural:
1. Congenital PUJ obstruction.
2. Ureterocele.
3. Neoplasm of ureter.
4. Narrow ureteric orifice.
5. Stricture ureter following removal of stone, pelvic surgeries or tuberculosis of ureter.

🔻C. Intraluminal:
1. Stone in the renal pelvis or ureter.
2. Sloughed papilla in papillary necrosis.

Bilateral
A. Congenital:
Congenital stricture of external urethral meatus, pin-hole meatus.Congenital posterior urethral valve.

B. Acquired:
BPH. Carcinoma prostate. Postoperative bladder neck scarring. Inflammatory/traumatic urethral stricture. Phimosis. Carcinoma cervix. Bladder carcinoma.

-Congenital PUJ is the most common cause of HN.

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PYONEPHROSIS:

-It is collection of pus in pelvicalyceal system, which is converted into a multiloculated sac.
-Occurs due to:
a. Infection of pre-existing hydronephrosis.
b. Following acute pyelonephritis.
c. As a complication of renal calculus, either stone in the renal pelvis or staghorn calculus.

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Criteria of colicky pain:

-Intermittent
-Hollow viscus
-Smooth muscles
-Peristalsis
-Distal obstruction.

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What's Nancy nail?

They can be used to treat femoral and tibial fractures in. children and adolescents, and humeral, radial, and ulnar fractures in both pediatric and adult patients. A 1.0mm diameter, 100mm length Nancy Nail is also available to treat metacarpal and metatarsal. fractures.

الدكتور السوسوة

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Three segments of Ureter:

1-Proximal from origin down to upper border of SI joint.

2-Middle, laying over the sacrum.

3-Distal, from the lower border of SI joint to its entry to UB.

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Sciatic nerve.

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DD of Acute app. in a child.

No PU,no Pancreatitis, no Biliary disorders.
Imp.
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Plus inflammation of Meckel’s diverticulum.

Femoral triangle.

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Femoral sheath.

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Femoral canal.
F. ring and S. opening.

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