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.

Remember:

The wall of NGT is entirely containing barium material, so it's opaque in X.ray.

However, there are some variants that only the end is containing barium.

#Surgery

Colon vascular supply

◼️The colon is supplied by both the superior and inferior mesenteric arteries which are branches of the aorta.

◼️The superior mesenteric artery (SMA) arise from the anterior surface of the aorta just below the celiac trunk at the level of the lower part of L1.

◼️SMA branches off the ileocolic artery (abscent in 20% of population) which supplies the terminal ileum and proximal ascending colon, it also gives the right colic and middle colic arteries that supply the distal ascending colon and transverse colon respectively.

◼️The inferior mesenteric artery arise from the aorta at about L3 vertebral level, it gives the left colic artery, several sigmoidal branches, and the superior rectal artery which supplies the proximal rectum.

◼️Each of these arteries communicate via anastomoses through the artery of Drummond, this circle of anastomoses is complete in only 15% to 20% of the population.

#Intestinal
#Surgery

Hernias and gender predilection

◼️Inguinal = Males more
◼️Femoral = Females more
◼️Paraumbilical =Females more
◼️Spigelian = Equal incidence.
◼️Obturator = Females more.

#Hernia
#Surgery

Layers of the abdominal wall from deep to superficial are

◼️Parietal peritoneum
◼️Extraperitoneal fat
◼️Transversalis fascia
◼️Transversus abdominis
◼️Internal oblique
◼️External oblique
◼️External abdominal fascia
◼️Skin

#Hernia
#Surgery

Differential diagnosis of a groin lump :

1) Indirect inguinal hernia.
2) Direct inguinal hernia.
3) Femoral hernia.
4) Enlarged cloquet lymph nodes.
5) Saphena varix.
6) Femoral aneurysm.
7) Encysted hydrocele of cord.
8) Hydrocele of canal of Nuck.
9) Hematocele of round ligament.
10) Ectopic testis.
11) Lipoma.
12) Psoas abscess.
13) Enlarged psoas bursa.
14) Ruptured adductor muscles.

#Hernia
#Surgery

Note

The most common strangulated organ in a female infant with indirect inguinal hernia is the ovary.

#Hernia
#Surgery