Reducible swellings:

1-Hernia
2-Meningocele
3-Varicocele
4-Saphena varix.

#Surgery

Swellings which are brilliantly transilluminant:

1-Ranula
2-Cystic hygromaand lymph cyst
3-Hydrocele
4-Meningocele
5-Epididymal cyst (Chinese-lantern pattern)
6Hydrocele of the canal of Nuck.

#Surgery

Cold Abscess:

-It is a soft fluctuant swelling without signs of inflammation, which is mistaken for a cyst.
-This is lined by granulation tissue and caseous material.
-It is due to tuberculous infection and contains tubercle bacilli.
-It is not hot.
-Brawny induration, edema and tenderness are absent.

#Surgery

Acute Abdomen definition:
-Any sudden spontaneous nontraumatic disorder affecting the abdomen for which urgent operation may be necessary and undue delay in diagnosis may adversely affect the outcome.

#Surgery

Swellings that move with deglutition?

1-Thyroid
2-Thyroglossal cyst
3-Subhyoid bursitis
4-Nodes attached to larynx and trachea
5-Laryngocele.

-Ascitic fluid less than 500 cc cannot be detected clinically.

-Minimal Ascites (500-1000cc).
-Moderated Ascites (1000-2000cc).
-Severe Ascitis (>2000 cc)

•Moderate amount: Shifting dullness.
•Tense: transmitted thrill.
•Minimal: knee - elbow.

#Surgery

Fluctuation:
-It's the transmission of an impulse in two directions at right angles to each other, and it implies presence of fluid in the swelling.

#Surgery

Sign of Moulding:

1-Sebaceous cyst
2-Dermoid cyst
3-Colonic mass with faecal matter.

#Surgery

Sleeping pulse rate:
Pulse rate counted early morning around 4 am, before the patient wakes up, without disturbing the sleep.

#Surgery

Symptoms of appendicitis

● Periumbilical colic
● Pain shifting to the right iliac fossa
● Anorexia
● Nausea

Signs to elicit in appendicitis:

● Pointing sign
● Rovsing’s sign
● Psoas sign
● Obturator sign

Clinical signs in appendicitis
● Pyrexia
● Localised tenderness in the right iliac fossa
● Muscle guarding
● Rebound tenderness

The patient is then asked to point to where the pain began and where it moved (the pointing sign).

#Surgery

Types of Hernia.
#Surgery

•Why do we ask the patient to turn his face to opposite side during Expansile impulse on coughing?
-To prevent coughing towards examiner.

•Pubic tubercle may be reached by following the tendon of adductor longus.

•Taxis is gradual reduction of contents of the scrotum by gentle manipulation by flexion, adduction and rotation of hip joint.

#Surgery

Deep ring occlusion test:

-When deep"internal" ring is occluded after reducing the contents, if impulse on coughing is absent in standing position then it is indirect inguinal hernia; if impulse on coughing is still present then it is direct inguinal hernia.

-It is the most important test in inguinal hernia.

-Deep/internal ring is located 1.25 cm above the mid-inguinal point.

-Midinguinal point is mid-point between the anterior superior iliac spine and pubic symphysis.

#Surgery

إذا أدى لك IVP أو KUB ويقول لك هل
plain
وإلا
plan
x ray
فأيش الفرق بين plain والـ plan ؟
Plain : without contrast
Plan  : with contrast.

Plain X-ray in Acute appendicitis:

May show the following:
-Lumbar scoliosis towards right due to psoas spasm which is not uncommon
-Faecolith on the right side;
-Obliteration of preperitoneal fat line due to retrocaecal appendicitis;
-Segmental ileus in caecum and terminal ileum
-Speckled extraluminal gas in right iliac fossa, gas in appendix,
-Pneumoperitoneum (very rare);
-Intestinal obstruction (occasionally only);
-Soft tissue mass in mass or abscess of appendix.

all these features are very much nonspecific. X-ray is useful to rule out DU perforation, intestinal obstruction, ureteric stone.

Also Radio-opaque appendix in a plain X-ray. It could be calcified or have calcified content.

د. فواز عمران يحب يسأل فيهن.

#Surgery

Differences between mass and abscess of appendix.

#Surgery

Some fractures the may heal without immobilization:

-Rib
-Scapula
-Clavicle.

#Surgery

Umblical and Para-umblical hernia.

-Imp.
#Surgery

Nerve supply of Appendix:

- T10 supplies the peritoneal coverings of the appendix, so reffered appendicular pain is felt at the umbilicus.

#Surgery

Descent of the Testes:

- At the 6th month of the intrauterine life, they lie at the internal inguinal rings(common site for undescended testis).

- At 7th month they go through the inguinal canal.

-At 8th month they lie at the external inguinal rings or at the neck of scrotum.

-They descend to scrotum just before birth.

#Surgery