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

Remember:

-Petersen's defect is defined as the potential space between the small bowel limbs and the transverse mesocolon after any type of gastrojejunostomy, especially the Roux-en-Y anastomosis.

#Surgery

Remember:

-The most common nerve injured during open hernia repair is the ilioinguinal nerve.

-The most common nerve injured during laparoscopic repair is the lateral femoral cutaneous nerve.

#Surgery

Summary of Hx:

-Age, gender,name, Important findings in personal history, Chief complaint, Analysis of chief complaint, Important findings in review of systems, with important negative findings!Important drugs,family and socioeconomic history, and your most probable diagnosis.

#Surgery

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.

#Surgery

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

#Surgery

Length, diameters and transit time of different parts of GIT.

#Surgery

-Double-contrast barium enema is a form of contrast radiography in which x-rays of the colon and rectum are taken using two forms of contrast to make the structures easier to see.

-Barium is a silver-white metallic compound that outlines the colon and rectum on an x-ray and helps show abnormalities.

-Air is also put into the rectum and colon to further enhance the x-ray.

-Double contrast  barium meal is done by giving effervescent tablets  along with barium.

#Surgery

An example of Double-contrast barium enema.