surgical short cases Flashcards
what are the symptoms of an inguinal hernia
- communicating hydrocele trasilluminates and is fluctuant hydrocoele of the cord:in females might be irreducible ; in male may be brought down into the scrotum and then get it above undescented testis and scrotum on the side is emptyis often associated with a hernia
What are the anatomical different types of hernia?
- inguinal 2. femoral 3. umbelical 4. incisional 5. rare types
What are the symptoms you are looking for in a femoral hernia?
- enlarged lymphnodes - lymphadenopathy 2. saphnea varix appears thin and blue - compressible and feel a thrill 3. ectopic testis occupying an abnormal position
What are symptoms of an umbilical hernia?
they are often irreducible and have narrow necks
where do femoral hernias appear
below groin crease below and lateral to the pubic crease
which ethnic group are umbilical hernias most common in
african descent children
What type of umbilical hernias are common in adults
paraumbilical
who are paraumbilical hernias frequent in ?
middle aged multiparous obese women
What is an incisional hernia?
an incomplete healed surgical wound
What are rare types of hernias
obturator, lumbar, spigelian
How do you distinguish between an inguinal and a femoralhernia?
reduce and cover the pubic tubercle have patient cough if inguinal -above the pubic tubercle and medial if femoral- under the and lateral
How do you distinguish between an inguinal and a femoral hernia?
reduce and cover the pubic tubercle have patient cough if inguinal -above the pubic tubercle and medial if femoral- under the and lateral
how do you differentiate a direct and indirect hernia
deep ringoclusion test mid way between pubic tubercle and asis- put finger there and reduce hernia- if cintained and does not come out when cough- indirect
What do you look for during a history of the breast examination?
Pain : any pain? cyclical (fibroadenosis) non cyclical constant localized pain (breast cancer)?
Lump: How fast do they grow? change with period (cyst if disappear)
nipple discharge: Any? colour? (discharge common in benign but colour a good indicator (bloody, green, serous occur in fibroadenosis))
previous breast disease: breast disease in the past? Management?
Menstrual history: age of menarch and menopause? oral contraception and hormone replacement therapy?
obstetric history: breast feeding? compication due to breastfeeding?
family history: breast or bowel cancer in the family
What do you look for in the inspection phase of a breast examination?
Size and shape of the breast: asymetry?
appearance nipples: inversion (malignancy)? eczema (padget’s)
Lumps?
symmetry: hands pressed on hips, contracted pectoral muscles
skin changes: erythema, oedema (peau d’orange)
skin dimpling or puckering
prominent veins
What do you do in the phase of palpation?
- palpate all 4 quadrants, areola, nipple axillary tail of breast with flat fingers
- attempt to express discharge by firm palpation
- bimanually asking the patient to lean forward
What are symptoms of varicose veins
- pain after standing for long time especialy when hot
itching around ankles
pigmentation
swelling
ulceration
thrombophlebitis
What do you ook out for when palpating varicose veins
localised tenderness
thickening and induration which implies thrombophebitis
ulcers
oedema around the ankles
defect in the deep fascia due to perfortor incompetence
what are the tests for varicose veins?
trendelenburg test: put the finger on the femoral artery- collapse the vein
tournique test
duplex ultrasound
how do you distinguish between the short and long saphenous vein
long is medial anterior
posterior and lateral
What symptoms are you looking out for in a thyroid examination?
