E Flashcards
Contents of the inguinal canal ‘rule of
3’s’
• 3 arteries: testicular, cremasteric and vas deferns • 3 nerves: genitofemoral, sympathetics, ilio inguinal nerve (only structure outside the spermatic cord and commonly damaged during repair) • 3 other: lymphatics, vas deferens, pampiniform plexus
Borders of the inguinal canal MALT:
• Roof = Muscle, internal oblique • Anterior wall = Aponeurosis external oblique (internal oblique lateral third) • Floor = Ligament, inguinal ligament • Posterior wall = Tendon, transversalis fascia and conjoint tendon
Femoral vs Inguinal Hernia
Fem - Lat and inf to pubic tubercule
Ing - Med and sup to pubic tubercule
Hernia?
Definition: protrusion of a viscus out of its cavity into an
abnormal position through a defect in the wall of the cavity.
What are the classical signs of bowel ischaemia?
- Acute severe abdominal pain
- Hypovolaemic shock
- Absence of abdominal signs
AKI STage 1
rise in cr >1.5x baseline
or by 26.5 in 48hrs
UO <0.5ml/kh/h for 6 hrs
AKI STage 2
Rise in Cr >2-2.9 x baseline
UO <0.5ml/kg/h for 12 hours
AKI STage 3
Rise in Cr >3 x baseline
UO <0.3ml/kg/h for 24 hr or anuric for 12hr
CKD needing dialysis
A - acidosis pH <7.2 Electrolytes - hyperK Intoxication - SLIME Overload fluid Uraemia
Horner’s syndrome
Features miosis (small pupil) ptosis enophthalmos* (sunken eye) anhidrosis (loss of sweating one side)
3rd N Palsy
ptosis
dilated pupil
down and out
Ottawa Knee - perform x ray if any one of these presents
- over 55
- cant flex to 90 degrees
- tender on palpation of fibula head
- discomfort confined to patella on palpation
- inability to weight bear - immediately and in ED
Ottawa Ankle
ankle xray
- any pain in malleolar zone and any of these
- bone tenderness at posterior edge/ tip lateral mallelous
- bone tendernes at posterior edge/ tip of medial malleolus
- inability to bear weight immediately and in ED
Ottawa Foot
pain in midfoot
- bony tenderness at base of 5th metatarsal
- bony tenderness at navicular
- inability to bear weight both immediately and in ED
LLOAF
Lateral 2 lumbricles
Opponens pollicis
abductor pollicis
flexor pollicis brevis
Rockall Score
Pre-Endo - age - shock: BP, pulse - comorbidities Post Endo source of bleeding - active bleeding - diagnosis initial >3 or final >6 = surg!
Child-Pugh Grading of Cirrhosis
- Albumin
- Bilirubin
- Clotting
- Distenstion - Ascites
- Encephalopathy
3 categories for each and up to 3 points for each.
>8 = significant risk bleeding
Exudate
due to inflammation causing increased capillary permeability
pneumonia, cancer, ai
transudate
due to increased hydrostatic pressure/ low plasma oncotic pressure
ccf, cirrhosis, nephrotic syndrome
TLS
high urate
high phosphate
high potassium
low calcium
renal failure
hydrate!!
high risk WBC>50 = rasburicase
mod risk WBC 10-50 = allopurinol
Indirect Hernia
Through deep ring
direct hernia
through the wall - hesselbachs triangle
