❇️Clinical features of raised ICP
▪︎Headache
▪︎Nausea and vomiting
▪︎Restlessness, agitation or drowsiness
▪︎Slow slurred speech
▪︎Papilloedema
▪︎Ipsilateral sluggish dilated pupil which then becomes fixed (“blown pupil”)
▪︎Cranial nerve palsy (e.g. CN III palsy with ‘down and out’ pupil)
▪︎Seizures
▪︎Reduced GCS
▪︎Abnormal respiratory pattern
▪︎Abnormal posturing, initially decorticate and then decerebrate
▪︎hypertension
▪︎bradycardia
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎Headache
▪︎Nausea and vomiting
▪︎Restlessness, agitation or drowsiness
▪︎Slow slurred speech
▪︎Papilloedema
▪︎Ipsilateral sluggish dilated pupil which then becomes fixed (“blown pupil”)
▪︎Cranial nerve palsy (e.g. CN III palsy with ‘down and out’ pupil)
▪︎Seizures
▪︎Reduced GCS
▪︎Abnormal respiratory pattern
▪︎Abnormal posturing, initially decorticate and then decerebrate
▪︎hypertension
▪︎bradycardia
#Surgery_rotation
https://t.me/Surgery_Practice
❇️Signs of skull fractures
▪︎CSF (clear fluid) leaking from nose or ear
▪︎Raccoon (Panda) eyes: bruising around the eyes (Fracture of the base of the skull)
▪︎Battle sign: bruising behind the ear over the mastoid process (Fracture in the posterior Cranial Fossa)
▪︎Haemotympanum: blood noted behind the tympanic membrane on otoscopy
#Surgery_rotation
https://t.me/Surgery_Practice
▪︎CSF (clear fluid) leaking from nose or ear
▪︎Raccoon (Panda) eyes: bruising around the eyes (Fracture of the base of the skull)
▪︎Battle sign: bruising behind the ear over the mastoid process (Fracture in the posterior Cranial Fossa)
▪︎Haemotympanum: blood noted behind the tympanic membrane on otoscopy
#Surgery_rotation
https://t.me/Surgery_Practice
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)
#Surgery_rotation
#Hernia
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)
#Surgery_rotation
#Hernia
https://t.me/Surgery_Practice
❤3
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
❤2
👍2