-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

-Fever and tachycardia are commonly absent in acute cholecystitis; maintain
a high index of clinical suspicion!

-Fever is also absent in case of cystitis.
#Surgery

Remember:

In compartment syndrome.

-Pain out of proportion to injury (typically first and most significant symptom).

-Pain with passive stretch (most sensitive sign).

-5Ps:late signs-do not wait for these to develop to make the diagnosis!!

-Tornoto notes
#Surgery

Indications

-Direct hernia.
-Recurrent hernia.
-Re-recurrent hernia.
-Incisional hernia.
-Old age.
-Hernia with weak abdominal muscle tone.
-Sliding hernia.

Complications:

-Infection.
-Mesh extrusion.
-Foreign body reaction.
-Mesh inguinodynia causing hyperaesthesia and pain along the distribution of ilioinguinal or iliohypogastric nerve.

Contraindications:
-In strangulated hernia, Why?
Because the field is potentially infected.

#Surgery

Types:

Synthetic:
-Prolene mesh (white in colour)see above.
-Dacron mesh,
-Morlex mesh,
-Mersilene sheath.

Biological:"Not used nowadays".
-Tensor fascia lata,
-Temporal fascia and skin.

#Surgery

Synthetic mesh.

Criteria of an ideal mesh.
#Surgery

Blood and Nerve supply of GB.

#Surgery

Note:
About venous drainage , do not say cystic vein .
Say Small veins pass from the galbladder through its bed directly into tributaries of the right portal vein within the liver.

لأن الدكاترة ما يعجبهم تقول cystic vein ..!!

#Surgery

Note:

Celiac trunk →Common hepatic artery →Proper hepatic artery →Right hepatic artery →Cystic artery .