Important knowledge

Origin of Testicular appendages epididymal appendage ( epididymis around testis) = wolf ( Wolffian duct ) testicular appendage ( ball in center) = water incide ball = مي (Müllerian duct)

Nutcracker syndrome is a rare vein compression disorder. It occurs when arteries, most often the abdomen's aorta and superior mesenteric artery, squeeze the left renal (kidney) vein. It can cause many symptoms in both children and adults, such as flank pain , blood in the urine and varicocele

⚡️The cremasteric reflex is often absent with testicular torsion, but a positive reflex does not reliably exclude torsion

⚡️Wearing signs in inguinal hernia ( نكول للاهل اذا شفتو هاي العلامات تجيبو ركض ) - redness - tenderness - irreducible mass - vomiting & abdominal distention - constipation

⚡️ بينما ابو ال undesended tests ننتضر عليه لعمر السنه اذا منزلت نسوي عمليه بعمر السنة لان اغلبهم تنزل spontaneously قبل عمر السنه So time of surgery is around 1 Y.O age

⚡️ الطفل الي عندة inguinal hernia كل ماكان عمرة اصغر كل مازاد ال risk of complications مثل ال obstruction وال strangulation وكذلك testicular atrophy بسبب الضغط على ال blood supply بال inguinal canal فبهل حاله كلما كان عمر الطفل اصغر لازم نستعجله بالعمليه ( ابو الشهرين نكله هسه تسويها متعوفها خلال اسبوع بينما ابو ٥ سنوات ممكن نتظر عليه شويه كم شهر مثلا) والمفهوم الشائع انو بعدة صغير خل يكبر ميتحمل بنج كلها مفاهيم خاطئة وتتسبب بالعديد من الحالات الكارثيه بال Inguinal hernia لذلك جدا مهم ننتبه لهاي النقطة

⚡️ direct inguinal hernia is very rare in children so when found direct I. Hernia search for connective tissue disorders and ask about prior inguinal surgery which it is risk factors .

Gastrointestinal tract duplications

⚡️Any child presenting with hemoglobin-positive stool and chronic anemia should be evaluated for a Meckel diverticulum ( Sometime the bleeding is slow and not clinically evident )

⚡️50% of lower GIT bleeding in children is caused by Meckel diverticulum

⚡️The most common congenital malformation of the gastrointestinal tract is Meckel diverticulum

⚡️classical triad of intussusception (<25% of patients) 1) intermittent abdominal pain 2) red-currant jelly stool 3) sausage-shaped abdominal mass

⚡️Guarding this is the most specific clinical finding in children with acute appendicitis.

Esophagial perforation triad 1) dyspnia 2) dysphagia 3) fever

⚡️ the narrowest part of the GIT is the upper esophageal sphincter (70% of ingested foreign bodis impacted here )

⚡️Presentation of colidocal cyst Infants = cystic type = RUQ abdominal mass + obstructive jaundice Children = fusiform type = RUQ colicky abdominal pain

Roux-en-Y hepatic portoenterostomy (Kasai operation) for biliary atresia results -1/3 will have inadequate bile flow ( liver transplant) -2/3 good bile flow (successful op.) and those divided into: ----- <50% will continue over life ----- >50% wil deve progressive obliteration of the intrahepatic biliary few years later

Porta hepatis is the hilum of liver

Triangular cord sign Biliary atresia