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.

#Surgery

Lipoma.

#Surgery

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

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

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

مثل هذه الملاحظات عبارة عن معلومات كانت إجابات لأسئلة الدكاترة اللي وردت في تجارب الطلاب في الدفع السابقة و كذلك بعض تجارب دفعتنا...

.

Clinical Surgery Pearls.

It's a nice clinical book in selected issues in surgery, in form of questions and answers with focus on practical side.

It's really an amazing book, especially the layout of information .

Submandibular gland

◼️It is smaller than the parotid gland, but larger than the sublingual gland.

◼️On each side, the submandibular gland consists of two parts, the superficial part is outside the bounderies of the oral cavity and it lies beneath the mylohyoid muscle (see fig), it has a greater volume than the deep part of the gland.

◼️The deep part loops around the posterior margin of mylohyoid muscle to enter the floor of the oral cavity, it is lateral to the base of the tongue lying on the outer surface of hyoglossus muscle.

◼️The deep part makes an impression on the inner aspect of the mandible, which is known as the submandibular fossa.

◼️The submandibular duct (Wharton's duct) emerge from the medial aspect of the deep part, and passes forwards in the floor to open beside the base of the lingual frenulum.

◼️The lingual nerve (a sensory nerve from the mandibular nerve) passes beneath the submandibular duct crossing it from a lateral to a medial direction (see above fig).

#Salivary
#Surgery

Sublingual gland

◼️It is the smallest of the three major paired salivary glands.

◼️The gland lies in the floor of the oral cavity immediately lateral to the submandibular duct (Wharton's duct) and associated lingual nerve (see previous post).

◼️The sublingual gland lies directly against the medial surface of the mandible making a shallow groove called sublingual fossa, it is above the anterior 1/3 of mylohyoid muscle. (see above fig).

◼️The superior surface of the gland raises a fold of mucosa at the floor of oral cavity known as the sublingual fold, which is easily visible, the gland is drained by numerous minor sublingual ducts that opens onto the crest of the sublingual fold.

◼️Occasionally the anterior portion of the gland is drained by a major sublingual duct that opens together with Wharton's duct besides the base of the lingual frenulum.

#Salivary
#Surgery

Cases that are found in surgery ward :

Male ,Room1:

Epigasric hernia
Femoral fracture
Hernia "inguinal "
Neck swelling
Renal stone
Bilateral hernia .

Femoral fracture is post-operative "Young male".

The others are pre-operative .

Male ,Room 2:
Inguinal hernia
Inguinal hernia
Inguinal hernia .

Two cases have a previous history of operation for contralateral inguinal hernia .

Female ,Room 1:
Epigasric or umbilical hernia
GB
Fracture leg
Fracture
Umbilical or Epigasric hernia
Lung hydatid cyst "young pt".

The main presentation of the patient of pulmonary hydatid cyst is chest pain as her mother said.
She is seven years old.