Herina Examination (P1) ■
▪︎Assessing the groin lump to determine if it is a hernia or other pathology (e.g. testicular mass, lipoma, abscess, lymph node).
▪︎You should always assess both sides of the groin to avoid missing pathology.
▪︎Hernias of the groin typically present with the following clinical features:
•Single lump in the inguinal region
•Positive cough impulse (unless incarcerated)
•Soft on palpation
•Reducible (unless incarcerated)
•Unable to get above the lump during palpation
•Painless (unless incarcerated)
•Bowel sounds on auscultation (may be absent if incarcerated)
▪︎Not Herina :
•Multiple lumps (e.g.lymphadenopathy)
•Hard or nodular consistency (e.g. malignancy)
•Able to get above the lump during palpation (e.g. scrotal mass)
•Transillumination (hydrocoele)
•Bruit on auscultation (e.g. arteriovenous malformation)
#Hernia
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎Assessing the groin lump to determine if it is a hernia or other pathology (e.g. testicular mass, lipoma, abscess, lymph node).
▪︎You should always assess both sides of the groin to avoid missing pathology.
▪︎Hernias of the groin typically present with the following clinical features:
•Single lump in the inguinal region
•Positive cough impulse (unless incarcerated)
•Soft on palpation
•Reducible (unless incarcerated)
•Unable to get above the lump during palpation
•Painless (unless incarcerated)
•Bowel sounds on auscultation (may be absent if incarcerated)
▪︎Not Herina :
•Multiple lumps (e.g.lymphadenopathy)
•Hard or nodular consistency (e.g. malignancy)
•Able to get above the lump during palpation (e.g. scrotal mass)
•Transillumination (hydrocoele)
•Bruit on auscultation (e.g. arteriovenous malformation)
#Hernia
#Surgery_rotation
https://t.me/Surgery_Practice
Herina Examination (P2) ■
🔹Hernia Should first be examined like any mass by
▪︎Inspection For
Site/Size/Shape/Over Skin/Surrounding Skin/Symmetry/Number
▪︎Palpation
•Superficial ➡️ Hotness/Tenderness
•Deep ➡️ Mobility/Reducibility/Consistency/Edge/Lobules
▪︎Cough Impulse
▪︎Occlusion Tests
▪︎3 Finger Test
▪︎Invagination Test
▪︎Trans illumination Test
▪︎While the patient is standing upright. Inspect the inguinal and femoral canals and the scrotum for any lumps or bulges.
▪︎Ask the patient to cough; look for an impulse over the femoral or inguinal canals and scrotum.
▪︎Inguinal hernias : located above and medial to the pubic tubercle (Direct/Indirect).
▪︎Femoral hernias : located below and lateral to the pubic tubercle.
■ Is it Direct or indirect inguinal Hernia ? (Ring occlusion test)👇
1.Ask the patient To lie Down
2.Locate the deep inguinal ring (midway between the anterior superior iliac spine and pubic tubercle).
3. Manually reduce the patient’s hernia by compressing it towards the deep inguinal ring starting at the inferior aspect of the hernia.
4. Once the hernia is reduced, apply pressure over the deep inguinal ring (close it) and ask the patient to cough.
• If reappears: Direct inguinal hernia
• if not reappears : indirect inguinal hernia
▪︎Inguinal hernias can extend into the scrotum (indirect). So If a testicular swelling is noted or there is suspicion of an inguinal hernia, palpation of the scrotum should be performed : 👇
•When palpating an inguinal hernia in the scrotum you will not be able to get above the mass.
■Comparison
●Direct inguinal hernias:
•Mostly Occurs in adult males.
•caused by a weakness in the muscles of the abdominal wall (develops over time, or are due to straining or heavy lifting).
•Reappears after deep ring occlusion
•Not enter the Scrotum
•Reducible (Wide Neck)
●Indirect inguinal hernias:
•In children (Present at birth).
•caused by a birth defect in the abdominal wall (congenital).
•Enter the Scrotum (Pass with spermatic cord).
•Not reappears when close the deep ring
•Reducible (Wide Neck)
●Femoral Herina:
•weakness in the lower groin
•Mostly in females
•more prone than inguinal hernias to develop incarceration or strangulation
•Mostly not reducible (Narrow Neck)
#Hernia
#Surgery_rotation
https://t.me/Surgery_Practice
🔹Hernia Should first be examined like any mass by
▪︎Inspection For
Site/Size/Shape/Over Skin/Surrounding Skin/Symmetry/Number
▪︎Palpation
•Superficial ➡️ Hotness/Tenderness
•Deep ➡️ Mobility/Reducibility/Consistency/Edge/Lobules
▪︎Cough Impulse
▪︎Occlusion Tests
▪︎3 Finger Test
▪︎Invagination Test
▪︎Trans illumination Test
▪︎While the patient is standing upright. Inspect the inguinal and femoral canals and the scrotum for any lumps or bulges.
▪︎Ask the patient to cough; look for an impulse over the femoral or inguinal canals and scrotum.
▪︎Inguinal hernias : located above and medial to the pubic tubercle (Direct/Indirect).
▪︎Femoral hernias : located below and lateral to the pubic tubercle.
■ Is it Direct or indirect inguinal Hernia ? (Ring occlusion test)👇
1.Ask the patient To lie Down
2.Locate the deep inguinal ring (midway between the anterior superior iliac spine and pubic tubercle).
3. Manually reduce the patient’s hernia by compressing it towards the deep inguinal ring starting at the inferior aspect of the hernia.
4. Once the hernia is reduced, apply pressure over the deep inguinal ring (close it) and ask the patient to cough.
• If reappears: Direct inguinal hernia
• if not reappears : indirect inguinal hernia
▪︎Inguinal hernias can extend into the scrotum (indirect). So If a testicular swelling is noted or there is suspicion of an inguinal hernia, palpation of the scrotum should be performed : 👇
•When palpating an inguinal hernia in the scrotum you will not be able to get above the mass.
■Comparison
●Direct inguinal hernias:
•Mostly Occurs in adult males.
•caused by a weakness in the muscles of the abdominal wall (develops over time, or are due to straining or heavy lifting).
•Reappears after deep ring occlusion
•Not enter the Scrotum
•Reducible (Wide Neck)
●Indirect inguinal hernias:
•In children (Present at birth).
•caused by a birth defect in the abdominal wall (congenital).
•Enter the Scrotum (Pass with spermatic cord).
•Not reappears when close the deep ring
•Reducible (Wide Neck)
●Femoral Herina:
•weakness in the lower groin
•Mostly in females
•more prone than inguinal hernias to develop incarceration or strangulation
•Mostly not reducible (Narrow Neck)
#Hernia
#Surgery_rotation
https://t.me/Surgery_Practice
■Abdominal Examination (P1)
▪︎Inspection of the Abdomen For :
•Scars
•Abdominal distension
•Visible Pulsation/Peristalisis
•Drains/Stoma
•Dressings
•Caput medusae: engorged paraumbilical veins associated with portal hypertension (e.g. liver cirrhosis).
•Striae (stretch marks): caused by ascites, intrabdominal malignancy, Cushing’s syndrome, obesity, pregnancy.
•Hernias: ask the patient to cough and observe for any protrusions through the abdominal wall.
•Cullen’s sign: bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis. (Cullen Umbilicus)
•Grey-Turner’s sign: bruising in the flanks associated with haemorrhagic pancreatitis. (Grey Flank)
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎Inspection of the Abdomen For :
•Scars
•Abdominal distension
•Visible Pulsation/Peristalisis
•Drains/Stoma
•Dressings
•Caput medusae: engorged paraumbilical veins associated with portal hypertension (e.g. liver cirrhosis).
•Striae (stretch marks): caused by ascites, intrabdominal malignancy, Cushing’s syndrome, obesity, pregnancy.
•Hernias: ask the patient to cough and observe for any protrusions through the abdominal wall.
•Cullen’s sign: bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis. (Cullen Umbilicus)
•Grey-Turner’s sign: bruising in the flanks associated with haemorrhagic pancreatitis. (Grey Flank)
#Surgery_rotation
https://t.me/Surgery_Practice
👍2
■Abdominal Examination (P2)
■Palpation
▪︎Light palpation For :
•Tenderness
•Masses
•Rovsing’s sign (Appendicitis)
•Murphy’s Sign (Acute Cholecystitis)
•Rebound tenderness: when the abdominal wall compressed slowly, and released rapidly results in sudden sharp abdominal pain.
•Guarding: involuntary tension in the abdominal muscles that occurs on palpation associated with peritonitis
•Rigidity: Abdominal muscles stiffness and painful on touching induced by acute peritonitis
▪︎Deep Palpation For :
•Deeper masses.
▪︎Liver/Spleen/Kidney Palpation For :
•Enlargement
•Presence of Mass
■Percussion For :
•Ascites (Shifting dullness/Transmitted Thrills)
•Organ Percussion (Liver/Spleen/Kidneys)
■Auscultation For :
•Bowel sounds (in RLQ area of ileocaecal Valve)
•Bruits (Renal/Aortic Artery)
#Surgery_rotation
https://t.me/Surgery_Practice
■Palpation
▪︎Light palpation For :
•Tenderness
•Masses
•Rovsing’s sign (Appendicitis)
•Murphy’s Sign (Acute Cholecystitis)
•Rebound tenderness: when the abdominal wall compressed slowly, and released rapidly results in sudden sharp abdominal pain.
•Guarding: involuntary tension in the abdominal muscles that occurs on palpation associated with peritonitis
•Rigidity: Abdominal muscles stiffness and painful on touching induced by acute peritonitis
▪︎Deep Palpation For :
•Deeper masses.
▪︎Liver/Spleen/Kidney Palpation For :
•Enlargement
•Presence of Mass
■Percussion For :
•Ascites (Shifting dullness/Transmitted Thrills)
•Organ Percussion (Liver/Spleen/Kidneys)
■Auscultation For :
•Bowel sounds (in RLQ area of ileocaecal Valve)
•Bruits (Renal/Aortic Artery)
#Surgery_rotation
https://t.me/Surgery_Practice
👍2
■Normal Vital Signs
▪︎Blood pressure:
•Normal Range:
120-140 systolic
80-90 diastolic
•ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
•high blood pressure is considered to be 140/90mmHg or higher
•low blood pressure is considered to be 90/60mmHg or lower
▪︎Breathing: 12 - 18 breaths per minute
▪︎Pulse (HR): 60 - 100 beats per minute
▪︎Temperature: 36.5 - 37.3 C
average 37°C
▪︎O2 Saturation: 95% - 100%
▪︎Urine output: 0.5 - 1.5 cc/kg/hour
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎Blood pressure:
•Normal Range:
120-140 systolic
80-90 diastolic
•ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
•high blood pressure is considered to be 140/90mmHg or higher
•low blood pressure is considered to be 90/60mmHg or lower
▪︎Breathing: 12 - 18 breaths per minute
▪︎Pulse (HR): 60 - 100 beats per minute
▪︎Temperature: 36.5 - 37.3 C
average 37°C
▪︎O2 Saturation: 95% - 100%
▪︎Urine output: 0.5 - 1.5 cc/kg/hour
#Surgery_rotation
https://t.me/Surgery_Practice
👍2
B Gray turner sign (at the flanks)
possibly ▶️ haemorrahgic pancreatitis.
Do Amylase or lipase blood test.
#Surgery_rotation
https://t.me/Surgery_Practice
❤2🔥1
Hepatomegaly + Splenomegaly +[- Kidney.pdf
1.2 MB
+++
Q/ Liver span ?
It is the distance between the lower border of the liver in the mid-clavicular line obtained by palpation, and the upper border of the liver in the mid-clavicular line detected by percussion (the upper border of the liver lies behind the ribs and can not be palpated)
Normally :- (12-14) cm
#Surgery_rotation
https://t.me/Surgery_Practice
Q/ Liver span ?
It is the distance between the lower border of the liver in the mid-clavicular line obtained by palpation, and the upper border of the liver in the mid-clavicular line detected by percussion (the upper border of the liver lies behind the ribs and can not be palpated)
Normally :- (12-14) cm
#Surgery_rotation
https://t.me/Surgery_Practice
PR examination - Bailey.pdf
1.7 MB
بيلي - مرتب اكثر بس متوسع