Liver and Testis

Liver & Testis Revision Dr.
Al Matary
testis Liver
Hydatid Disease of the liver

Hydatid Disease of the liver
hydatid
dilution
Page | 1
Liver & Testis Revision Dr. Al Matary
hydatid cyst
Echinococcus multiocularis
Echinococcus granulosus
Echinococcus multiocularis
Malignant hydatid
hydatid malignant
Page | 2
segments
gravid segment segment
segment
Embryo
Intestine
systemic portal
Portal GIT Portal
definitive host
cyst Inter mediate host
Page | 3
Embryo
Portal embryo
Cyst
blind end of life cycle
cyst
accidental inter mediate host
free
buttock
Page | 4
hydatid
Infection

blind end Life cycle
hydatid cyst
parasite
Page | 5
Laminated layer
Parasite
laminated layer
IQ
parasite laminated layer
laminated
fibrosis
fibrosis
adventitia
fibrosis
parasite
activity parasite
Page | 6
Parasite laminated layer

immune system adventitia
balance
Parasite
Parasite
balance
parasite
parasite
parasite
Na Cl
Parasite
Scolices
Page | 7
Scolices
Scolices
Broad capsule Scolices
broad capsule
broad capsule
Broad capsule
adventitia
Immune system
laminated layer
parasite
Parasite germinal layer

parasite
Na Cl
Scolices
Scolices
Broad capsule
Scolices
Page | 8
Hydatid cyst
laminated layer
under tension cyst
cyst cyst germinal layer

cyst cyst
daughter cyst
laminated layer trauma

Laminated layer
Under tension cyst

germinal layer Under tension
exo cyst daughter cyst
malignant hydatid
accidental intermediate host
blind end of life cycle
Immune system adventitia

parasite laminated layer
Parasite germinal layer
Scolices Hydatid fluid
hydatid cyst
Liable for complications
Complications
complications
Cyst, hemorrhage, rupture, pressure, infection & calcification
rupture
Page | 9
rupture
Anaphylaxis
Dissemination
anaphylaxis Peritoneum
small amounts of protein

small amounts of proteins

anaphylaxis
hepatic veins
Hydatid cyst
brain hydatid cyst
rupture
Anaphylaxis
Dissemination
dissemination anaphylaxis
common bile duct Scolices common bile duct ( CBD )
obstructive jaundice
Hepatic vein
Dissemination
common bile duct

Obstructive jaundice
periton
Page | 10
Anaphylaxis
anaphylaxis
dissemination hepatic vein
jaundice common bile duct
complications
Infection
calcification Pressure
anaphylaxis
dissemination hepatic vein
jaundice common bile duct
hydatid cyst
Clinical pictures
asymptomatic
hydatid cyst

Hydatid cyst
Hydatid cyst
Hydatid cyst
Hydatid cyst
Page | 11
Hydatid cyst
check up
swelling check up
Hydatid thrill
thrill
hydatid thrill Liver cyst
How ever
asymptomatic
liver cystic swelling
hydatid thrill
complicated
Jaundice common bile duct
anaphylaxis Periton
Hydatid cyst
asymptomatic
discovered accidently
thrill Liver cyst
pleural effusion Liver cyst

Sympathy
diaphragm diaphragm Sympathetic effusion
sub phernic abscess
sympathy Pleural effusion sub phernic abscess

dull resonant Percussion
Page | 12
dull Resonant
asymptomatic
liver cystic swelling
Pleural effusion
complications
check up
check up
check up
check up
thrilling
liver
cyst
cyst Liver
hydatid cyst
cyst
hydatid
Hydatid
Liver cyst
hydatid
document
serology
Complement fixation test
Page | 13
Serology CT scan diagnosis
serology ultra sound

serology CT scan
hydatid cyst
Diagnosis
diagnosis
Serology Ultra sound
Serology CT scan
Positive serology
Serology
Complement fixation
Indirect haemagglutination
Casoni
70 % 60 % accuracy
Indirect haemagglutination complement fixation

90 %
accuracy
Para
parasitology
complement
Page | 14
Indirect haemagglutination complement fixation
Hydatid cyst
common bile duct Hydatid cyst Hydatid cyst
Jaundice
Obstructive
Investigation
ERCP
Investigations
Liver function tests ( LFTs )
Kidney function tests (KFTs )
kidney
sonar
ERCP
Investigation of choice
ERCP
cyst common bile duct ERCP
cyst

hydatid cyst
cyst
cyst Hydatid
Page | 15
hydatid cyst
Sero
Serology
serology
hydatid cyst

serology
Treatment
hydatid cyst
complications
complications Hydatid cyst

complications
anaphylaxis
Complications
Hydatid cyst Main line of treatment
Surgery sandwiched in medical treatment
surgery
medical treatment
Medical treatment surgery medical treatment
medical treatment
surgery
medical treatment
medical treatment
antigenicity
Page | 16
antigenic
antigenicity
cyst
Parasite
cyst
Parasite
Parasite Medical treatment
surgery
medical
Medical treatment
Medical treatment
surgery sandwiched in medical treatment treatment
Medical treatment
brain Hydatid cyst medical treatment
Liver lung
medical treatment hydatid cyst
Medical treatment
medical treatment
Page | 17
one
One month Mebendazole 200 mg
Albendazole
Mebendazole
Enucleation
plane of cleavage
laminated layer adventitia

plane of cleavage
adventitia immune system laminated layer Parasite
adventitia
Enucleation
Enucleation
Under tension cyst
daughter cyst adventitia
Parasite
Parasite Medical treatment
adventitia
adventitia

adventitia
Enucleation
hypertonic saline
Betadine
Formalin
Page | 18
parasite
parasite
cyst under tension
Double way syringe
cyst under tension
surgery medical treatment

Parasite
Under tension
cyst
medical treatment
adventitia
double way syringe
Enucleation
Parasite
laminated layer
germinal layer
germinal layer
Parasite
cavity
cavity
Omentum
Omentum
omentoplasty Enucleation
Page | 19
omentoplasty Enucleation
Hydatid cyst
Partially lobectomy
Amoebic liver Abscess

Entamoeba
Entamoeba
Primitive
Entamoeba Histolytica
Entamoeba
Host parasite relationship

host parasite relationship
Entamoeba
cysts stool analysis
cyst
Page | 20
Entamoeba
Entamoeba
Entamobea
Entamobea
Entamoeba
Entamoeba
Proteolytic enzymes
Amoebic ulcer
dysentery
blood vessel
Blood vessel
blood Mucous
Entamobea blood vessel
Entamoeba blood vessel
Page | 21
blood vessel Entamoeba

Entamoeba
Portal Liver
Liver
blood vessel Liver
Liver Entamoeba
Liver Entamoeba
rabbit coco nut
Page | 22
Entamoeba
Entamoeba
Liver
Entamoeba
Entamoeba
Coalesce amoebic hepatitis

Coalesce
Stool
Entamoeba
Entamoeba
anchovy sauce Chocolate
Irregular chaggy amoebic liver abscess wall

chaggy
Chaggy
irregular chaggy
Page | 23
anchovy sauce
false abscess amoebic liver abscess

true abscess
not a true abscess amoebic live abscess

true abscess amoebic liver abscess
pyogenic membrane
true abscess amoebic liver abscess

pyogenic membrane
amoebic liver abscess is not a true abscess
pyogenic membrane
true abscess
true abscess secondary infection
Liver amoebic liver abscess

fibrosis amoebic liver abscess
Hydatid cyst
fibrosis
fibrosis amoebic liver abscess
chronic
pyogenic membrane amoebic liver abscess
good immunity chronicity
Means good immunity chronicity
parasite
good immunity means chronicity
complications amoebic liver abscess
Page | 24
Complications
Cyst, hemorrhage, rupture, infection, pressure and calcification
common bile duct amoebic liver abscess

Jaundice
Jaundice
Obstructive jaundice
Hydatid cyst amoebic liver abscess

Proteolytic enzymes
amoebic liver abscess
diaphragm
diaphragm
striated muscles

proteolytic enzymes
Lung
diaphragm
dyspnea
fatal
Page | 25
fatal Entamoeba
Fatal Amoebic myocarditis
Entamoeba
Proteolytic enzymes
diaphragm
diaphragm
Proteolytic enzymes
amoebiasis cutis
Entamoeba
Amoebiasis cutis
amoebiasis cutis
Clinical pictures

acute cholecystitis but, major pain and minimal fever
Acute cholecystitis but, major pain and minimal fever
Type of patient
radiating to the right shoulder right hypochondrium Pain
Page | 26
rebound tenderness regidity

Pain
acute cholecystitis
fever
Major pain and minimal fever

acute cholecystitis biliary colic amoebic liver abscess
Incidence
radiating to the right shoulder right hypochondrium Pain
edema rebound tenderness regidity
acute cholecystitis

sonar
clinical
clinical
Major pain and minimal fever
Sonar
Normal gall bladder
normal gall bladder sonar

colitis
Liver focal lesion
focal lesion
abscess
Liver focal lesion
hepatoma
pain
pain Hepatoma
hepatoma
Liver Focal lesion

pain hepatoma
Page | 27
Pain

secondary infection
clinical pictures
but major pain and minimal fever acute cholecystitis
Major pain and minimal fever acute cholecystitis
skin Inter costal muscles edema rebound tenderness regidity
Pleural effusion
diaphragm diaphragm sympathy
Sympathy

secondary infection
Investigations
amoebic liver abscess Investigations

test Ultra sound
amoebic liver abscess investigations

Ultra sound
test
right hypochondrium Pain

Radiating to the right shoulder
Acute cholecystitis
right shoulder radiating pain
edema rebound tenderness regidity
Page | 28
sonar
Normal gall bladder
Liver focal lesion
test amoebic liver abscess
Diagnostic & therapeutic
stool analysis
Entamoeba stool analysis
amoebic liver abscess Entamoeba stool analysis
biopsy sigmoido scope
Entamoeba
Investigations
text
right hypochondrium pain
stool stool analysis regidity edema
Page | 29
Ultra sound
test
CT scan
test
Jaundice common bile duct

ERCP
Investigation of choice Jaundice liver
ERCP
Treatment
mainly tissue amoebicidal
Mainly amoebicidal
Luminal
mainly tissue amoebicidal

Intestine lumen Entamoebea
tissues Mainly
amoebicidal Luminal mainly

tissue
Tissue
Luminal amoebicidal
tissue amoebicidal Luminal
tissue amoebicidal
Page | 30
tissue amoebicidal Liver Entamoeba
500 mg 250 mg
750 mg
250 mg
750 mg
neasuea metalic taste
tolerate
Patient compliance
Metalic taste
500 mg
500 mg 750 mg
Diagnostic
Therapeutic
Page | 31
anchovy sauce Necrotic tissue

Aspiration guided by ultra sound
anchovy sauce
exmainer
amoebiasis cutis
Entamoeba anchovy sauce

wall Entamoebea
cavity abscess Entamoeba
Entamoeba
Under cover of aspiration
amoebiasis cutis
covered by Entamoeba
Page | 32
mulilocular thick content

thick
thick
Multilocular
Loculi
by ultra sound
Indication for open drainage Multilocular thick

Thick
Multilocular
Rapid re-accumulation
Indication for open surgery
Open surgery
Right lobe
extra peritoneal extra pleural 12
sub phernic abscess

extra peritoneal extra pleural 12 sub phernic abscess
Left lobe of the liver

Mid line
Left right
Right lobe of the liver
Left Right
Page | 33
left lobe of the liver

3D 2D
amoebic myocarditis
Which is fatal
Indication for open surgery

:
Thick
Multilocular
Rapid re accumlation
Abscess in the left lobe of the liver
Left lobe of the liver abscess

amoebic myocarditis
Mid line Left lobe

extra peritoneal extra pleural 12 Right lobe
Hepatoma
Hepatoma
adenoma
GIT GIT Adenoma
Liver adenoma
GIT
Liver Adenoma
Page | 34
contra ceptive pills
Liver adenoma
Hormonal sensitive
Liver adenoma
contra ceptive pills
Liver
Liver
Hereditary chronic irritation benign tumor
malignant adenoma
malignant

pills
adenoma
sensitive Hormonal
contraceptive pills Liver adenoma

malignant Liver adenoma contraceptive pills
Rare malignant Rare
Page | 35
adenoma contraceptive pills

benign tumor adenoma
Malignant Rare
Liver adenoma
Pills
Pills
pills
Pills
conservative Liver adenoma

Hemo peritoneum Periton adenoma Unless
hemo peritonum periton adenoma
Hepatoma
hepatoma
Liver cirrhosis Hepatoma
health sudden deterioration any patient with liver cirrhosis Hepatoma

I have to think of hepatoma
Hepatoma Hepatoma
Hepatoma
Cirrhosis
Cirrhosis Hepatoma
Page | 36
Healthy liver hepatoma

rare
fibrolamellar type
fibrolamellar type Healthy liver
fibrolamellar type
fibrolamellar type
Liver cirrhosis Hepatoma
Hepatoma Liver cirrhosis
fibrolamellar type
clinical pictures of Hepatoma
Clinical pictures
Liver cirrhosis
Hepatitis Liver cirrhosis
well trained

Needle
Page | 37
Hepatitis C
Hepatitis C
Liver cirrhosis hepatitis C

easy fatigability
Hepatoma sonar
health sudden deterioration Any patient with liver cirrhosis

I have to think of hepatoma
sonar
Hepatoma clinical pictures
jaundice Hepatoma
terminal case ascites
terminal case
terminal Jaundice & ascites

Hepatoma
hepatoma
Health sudden deterioration Liver cirrhosis
Investigations
Hepatoma
Seminoma Hepatoma
tumor marker
fine needle aspiration
tumor marker hepatoma
fine needle aspiration
seminoma Hepatoma
tumor marker
Page | 38
treatment Formal hepatic resection Hepatoma

formal hepatic resection
anatomically resection
segment
Segmentectomy
Left hepatoectomy right hepatoectomy
Liver
Falciform ligament
Right lobe
Left lobe
plane of Cantlie
Liver
Liver
Falciform ligament
Liver
principal plane Cantlie's line
Inferior vena cava gall bladder

Principal plane Plane of Cantlie
Right liver
Left liver
Left lobe right lobe

Left liver right liver
Right surgical lobe

Left surgical lobe
Page | 39
segment left liver

segment right liver
segment Liver
segments
segments right liver segments left liver
principals plane
Left liver
right liver segments
principal plane anatomy
Left liver
right Liver
Hepatoma
anatomical hepatic resection
segmentectomy segment
segment Left surgical lobe Left liver

segments
segment right surgical lobe right liver

segments
Segmentectomy
Right hepatectomy
Left hepatoectomy
Left lobe segment right lobe
Page | 40
extended right hepatoectomy

right hepatoectomy extend
right lobe segment Left liver

extended left hepatoectomy
Left hepatoectomy extend
transplantation segment hepatoectomy

Liver transplantation
biliary atresia
segment
anatomical
segment
cirrhotic
segments
donor
Page | 41
Hepatoma
sex age type of patient
old age Male
predisposing factor
adenoma cirrhosis
adenoma Liver cirrhosis
Liver cirrhosis
malignancy rare adenoma
liver cirrhosis hepatoma
Post alcholic cirrhosis
Post hepatitis
Hemochromatosis
Wilson's disease
Wilson contraverse
hepatoma controverse
hepatoma Liver cirrhosis
Liver cirrhosis
Liver cirrhosis
rare adenoma
aflatoxins
Aflatoxins
Fungus
Page | 42
Hepatoma
fungus
aflatoxins
Cirrhosis
Adnoma
aflatoxins
Pathology
Macroscopic pictures of hepatoma
Star shaped mass
Solid organ
star shaped mass Solid organ
single
Multiple
Multiple
focus cirrhosis liver
examiner
multiple single
Liver
star shaped mass
star shaped mass
Single
Multiple
Mulitple

star shaped mass
Page | 43
signs of mitosis Loss of polarity Hepatocyte
fibrolamellar type
lamelle of fibrous tissue malignant hepatocyte
fibrolamellar type
fibrolamellar type
cirrhotic Liver
Malignant hepatocyte lamelle of fibrous tissue
alpha feto protein
Hepatoma
alpha feto protein tumor marker Hepatoma
alpha feto protein
alpha feto protein fibrolamellar type
Carboxy prothrombin
carboxy prothrombin Marker
alpha feto protein fibrolamellar type

carboxy prothrombin Marker
Liver cirrhosis fibrolamellar type average IQ

alpha feto protein
good prognosis
Healthy liver
cirrhotic liver
Liver Liver healthy liver
good prognosis good prognosis
Page | 44
good prognosis
spread
Direct
Lymphatic
Blood

health sudden deterioration Any patient with liver cirrhosis
I have to think in hepatoma
ascites Jaundice Late
Para malignant syndrome

Para malignant manifestations hepatoma
fever of unkown etiology
buffalo hump Moon face cushing

Cachexia buffalo hump moon face ACHT like
Hypertension diabetes
hepatoma
hypertension diabetes
Ectopic ACTH diabetes hypertension Hepatoma
buffalo hump moon face
Moon face
buffalo hump Moon face Cachexia

cirrhotic patient Health Sudden deterioration
ascites jaundice late
Para malignant syndrome

para malignant
clinical pictures Heptoma
Page | 45
Para malignant manifestation
Health sudden deterioration

health sudden deterioration

ascites Jaundice late
Para malignant manifestations
General
Cachexia
supra clavicular lymph nodes
site of virchow
sign
general examination
Cachexia
Virchow's
general 3/4
Virchow's Cachexia
local
Hepatoma
solid cystic Liver mass
Murmur
Mamoun sign sign
Page | 46
hepatoma
tumor Murmur
venous hum Murmur
Venous hum Murmur
arterial venous
arterial Murmur
venous venous hum
venous hum Portal hypertension

Liver venous hum portal hypertension
Murmur Hepatoma
venous hum venous hum
venous hum
pistol shot
rumbling murmur machinery murmur
diastolic rumbling murmur

arterial rumbling murmur
venous venous hum
augmentation
Page | 47
Investigations Hepatoma
tumour marker
CT scan
Marker
alpha feto protein
fibrolamellar type
carboxy prothrombin
angio
Angio
angio
hepatic angio
liver
Hepatic artery
Coeliac trunk
Aorta
femoral artery
external iliac
external iliac
common iliac
common iliac
Aorta
Aorta
Coeliac trunk
Coeliac trunk
Page | 48
Hepatic artery
Portal vein
Portal vein Hepatic artery Hepatoma

Liver
dual blood supply Liver
hepatic artery Hepatoma

Portal vein hepatic artery Hepatoma
hepatic artery Portal vein Liver

Hepatoma
Hepatic artery Hepatoma
angio
hepatic artery
portal vein
dark Hepatoma
dark Hepatoma Liver
regional chemotherapy
Hepatic artery
Portal vein chemotherapy

Hepatoma Liver
hepatic artery chemotherapy

Portal vein
Hepatoma Liver
hepatic artery angio
Hepatoma
Portal vein angio
dark hepatoma
Hepatoma
tumor marker CT scan
Page | 49
hepatoma
angio
Investigations
polycythemia CBC
fasting blood sugar

diabetes
complications
Hepatoma
Marker & CT scan
Marker & ultra sound
hepatoma
angio
Treatment
Hepatoma
Operable
Inoperable
System
Operable
Formal hepatic resection

right hepatectomy left hepatectomy segment
cirrhotic liver
safty margin
Liver transplantation contraverse
Page | 50
cirrhotic Liver
safty margin
Liver transplantation cirrhotic liver
liver transplantation Hepatoma
transplant recurrent
transplant Liver recurrent

hepatoma
transplant
Immune suppression chemotherapy
Hepatoma Liver transplantation

transplant recurrence
200
hepatoma
Liver hepatoma
donor
donor
donor
Page | 51
left lobe
Liver transplantation controverse

hepatoma Liver transplantation
Hepatoma
Operable
Inoperable
system
operable
by hepatic resection
Inoperable
Guided by ultra sound
cryosugery
Page | 52
Microwave
radio frequency
radio frequency
alcohol
marked necrosis necrosis
chemical necrosis
feeding vessel
hepatic artery Left branch Hepatic artery right branch
Hepatic artery right branch

right branch of portal vein
Portal vein Hepatic artery hepatoma

Hepatic artery
left branch right branch of hepatic artery

Left branch right branch
Liver Metastasis
Liver secondaries
commonest
commonest
the most common malignant Liver secondaries
Page | 53
Umbilicated
Inoperable
Except
Cancer colon
cancer colon
radical resection metastasis

cancer colon
Liver secondaries
cancer colon
secondaries
Liver secondaries
Hepatoma Common
Hepatoma
hepatoma secondaries
Liver Metastasis
umbilicus central necrosis Umbilicated Multiple
secondaries central necrosis
Liver secondaries
seondaries
Clinical picture of the cause
secondary
disease clinical pictures of the cause
clinical picture of the cause
Page | 54
Liver metastasis
Loss of function swelling liver pain
function jaundice swelling
loss of function swelling pain Liver Clinical pictures of the cause
Liver secondaries Investigations
Investigations for diagnosis

Investigations for staging
Follow up
Investigation
staging
CT scan
900 19
investigation for diagnosis
Diagnosis of the
Of the
Investigations for staging

Metastasis
Iiver Metastasis
CT scan
MRI CT
MRI CT
MRI CT
carcino embryonic antigen Metastasis Marker
MRI
accuracy
19 MRI
accuracy
CT
Page | 55
carcino embryonic antigen Marker
Liver Metastasis
Portal vien
Hepatic artery
Liver
Hepatic vein
Hepatic vein Metastasis

Liver
Liver
direct spread portal vein Hepatic artery

hepatic artery
Portal vein
direct spread
MCQ
hepatic flexion cancer colon
Liver
Liver metastasis
treatment
Liver metastasis Hepatic flexure carcinoma
radical
hepatectomy right hemicoloectomy
segmentectomy wedge resection metastasis
right hemicolectomy
operable Metastasis cancer colon
Liver
Page | 56
testis
Testis
Liver testis
testis
gabernaculum testis cord

gabernaculum cord testis
testis
scrotum gabernuclum cord
Accessory tails
accessory tails
femoral trinagle
superficial inguinal pouch
femoral triangle
abdomen femoral triangle
adductor longus Sartorius Inguinal ligament femoral trinagle

adductor longus
Medial border of adductor longus
anatomy
accessory tails testis
Page | 57
femoral trinagle
femoral tringle
femoral triangle
femoral triangle
Inguinal ligament
sartorius

triangle adductor longus
triangle Sartorius
Sartorius
medial border of adductor longus adductor longus

Lateral
triangle adductor longus
sartorius sartorius
triangle adductor longus Medial border of adductor longus
femoral triangle
medial border of adductor longus Sartorius Inguinal ligament
femoral triangle
examiner
femoral triangle accessory tails

external oblique Scarp's fascia
Page | 58
external oblique Scarp's fascia superficial inguinal pouch

Scarp's fascia
external oblique
Scarp's fascia
external oblique
superficial inguinal pouch testis

Internal oblique Scarp's fascia superficial inguinal pouch

Scarp's external oblique Scarp's fascia external oblique Scarp's fascia
external oblique Scarp's fascia external oblique fascia

Lower abdomen Scarp's fascia

external oblique
examiner
anatomy
lower abdomen external oblique Scarp's fascia
Page | 59
root of penis
root of peins
Perineum
Perineum
scrotum anus
vagina anus
undescended testis
Perineum scrotum anus

accessory tails
Femoral triangle
Superficial inguinal pouch
Root of penis
Perineum
Imperfected descent of the testis
testis
gabernuculum cord
accessory tails
accessory tails
testis
Go
testis
testis
gabernuculum cord
gabernuculum cord
testis
Page | 60
scrotum
testis
gabernuculum
gabernuculum
testis scrotum
testis
testis
scrotum
testis
scrotum testis
scrotum testis
go
cord
cord gabernuculum
testis
testis
cord
testis
gabernuculum cord testis
testis Inguinal canal

fibrous tissue
testis
Page | 61
cord
gabernuculum
gabernuculum
cord
go
cord
gabernuculum
testis
testis
scrotum Inguinal canal

gabernuculum scrotum

Perineum
root of penis
accessory tails
testis
Lockwood theory theory
undescended testis
Maldescended testis
embryology
Page | 62
Urogenital testis
Uro genital ridge
Uro
Genital
urinary system congenital anomaly undescended testis 13.5 %
embryology
left testis right testis
go
Jump left testicle
right testicle left testicle Most always
left testis right testis
left testicle
right testicle
right
left side undescended testis right side undescended testis
right side
left side undescended testis right side undescended testis
embryology
undescended testis pre mature babies

Undescended testis pre mature babies 30 %
testis Pre mature
Page | 63
4% 30 %
0.8 % adulthood
testis
testis testis
Just
MCQ
Undescended testis Maldescended testis
scrotum
Maldescended testis undescended testis
scrotum
well developed scrotum

Not well developed scrotum
Undescended testis
Not well developed scrotum
Mal descended testis
Page | 64
scrotum
Maldescended undescnded
Undescended testis
scrotum
well developed
not well developed
testis well developed
scrotum Median raphe

deviated
developed Maldescended testis
deviation median raphe
median raphe shift maldescended testis

Undescended testis median raphe shift
bilateral undescended testis
Sterility
Sterility
female male
scrotum bilateral undescended testis
clitrois penis
clitrois vaginal atresia female
bilateral undescended testis Male
maldescended undescended Inspection
Page | 65
Undescended testis
examiner
undescended testis
median raphe deviation Undeveloped scrotum

So, I suggest
undescended testis
How ever
I ll confirm the diagnosis
Perineum root of penis
Penis
scrotum
femoral triangle Inguinal ligament
superficial inguianl pouch Inguinal ligament
testis
Maldescended testis
well developed scrotum maldescended testis
testis
undescended testis
Inguinal canal Undescended testis
testis
external oblique aponeurosis
inguinal canal
dysgensis

fascia transversalis
sandwiched between testis
testis
Sandwiched between
Page | 66
fascia transversalis
inguinal canal superficial inguinal pouch

external oblique deep inguinal pouch Inguinal canal
external oblique Inguinal canal superficial inguinal pouch

external inguinal canal superficial inguianl pouch
oblique
external oblique Maldescended testis

external oblique undescended testis
external oblique
maldescended testis
undescended testis
deep inguinal pouch Inguinal canal
Inguinal canal deep inguinal pouch testis
external oblique testis external oblique

testis fascia transversalis
Maldescended testis
Undescended testis
undescended testis
clinically right side undescended testis
Page | 67
diagnosis Inspection examiner
scrotum
not well developed
deviation Median raphe
median raphe
median raphe
Median raphe scrotum
median raphe deviation

Median raphe
how ever
I ll confirm my diagnosis
femoral triangle superficial inguinal pouch perineum root of penis
This confirm my diagnosis
undescended testis
Inguinal canal undescended testis

Inguinal canal
fascia transversalis external oblique testis
scrotum
Page | 68
spermatogensis
35
rectal temperature 37.5

scrotum testis
scrotum
scrotum
scrotum
pampiniform plexus of veins
testis
scrotum
testis
testis
electrone microscope damage

electrone microscope
Light microscope damage
Minimal Minimal
damage Light microscope
electrone microscope
damage electrone microscope
16
Undescended testis
Page | 69
16
endocrine function exocrine function testis

endocrine
testosterone endocrine sperms excorine function
exocrine
Puberty endocrine function
erection
erection
ejacualtion
secretion seminal vesicles
azospermia semen
undescended testis
undescended testis
Intact hormonal function
spermatogenesis exocrine
Infertility bilateral undescended testis
seminoma
Page | 70
Undescended testis
lesion
Undescended testis
damage minimal
30 seminoma
Normal
seminoma
testis seminoma
dysgenesis
dysgenesis
seminoma
Incidence of seminoma
scrotum the same Incidence of seminoma
dysgenesis dependent Incidence of seminoma
Page | 71
dependent
complications
Infertility
seminoma
Infertility
the same high incidence of seminoma
30 Undescended testis
Normal
seminoma Normal 30
Normal
10,000 1 Normal
seminoma Undescended testis 100,000 10,000
Undescended testis
follow up
Normal 30 high incidence seminoma

follow up
rare incidence seminoma
young adult malignant testicular tumor

testis Malignancy
testis malignancy
Page | 72
young adult Malignant testicular tumors
rare
common Normal 30
testis
follow up
to preserve
the same incidence of seminoma
torsion
torsion Undescended testis
torsion Normal testis

torsion
torsion of the testis
There is no torsion on top of normal testis
normal testis
scrotum testis tunica vaginlais

testis
testis scrotum
tunica vaginalis
scrotum testis
testis
tunica vaginalis
testis
Page | 73
testis liable for torsion Undescended testis
undescended testis
Infertility
seminoma seminoma
torsion
undescended testis
torsion
Severe pain

Ischemia
severity vomiting Neasuea pallor Severe pain

Umbilicus
Lower abdomen
left iliac fossa Right iliac fossa
umbilicus pain around

T 12 dorsal segments T 10 testicular nerve testis
right iliac fossa Shifting
appendicitis
scrotum compartment
T10 testis around umbilicus Pain

scrotal compartment appendicitis right iliac fossa shifting
torsion
Page | 74
16
torsion
No torsion on top of normal testis
torsion undescended testis
appendicitis
Hernia Undescended testis
hernia common Undescended testis
85 %
MCQ
Hernia Undescended testis
strangulated hernia
acute abdomen Undescended testis

Torsion
strangulated hernia
hernia Undescended testis

85 %
acute abdomen strangulated hernia
right side undescended testis acute abdomen
Appendicitis
Torsion of the testis
Page | 75
Strangulated hernia
Undescended testis
Investigations
testis Investigations
Lumbar region
iliac fossa
Inguinal canal
Investigations
In accurate
Laparoscope accurate
laparoscope Investigations
50
70
70
13.5 % Undescended testis Urinary system

Urinary system anomalies
However
testis
solid testis
solid testis
cyst
cyst
Page | 76
solid testis
laparoscope laparoscope
testis
laparoscope
Laparoscope
Umbilicus
scrotum
laparo
laparoscope
external ring
Internal ring external ring
internal ring
Internal ring
testis
testis Internal ring
Internal ring
canal Inguinal canal
testis
vanished
Intra uterine torsion

intra uterine torsion vanishing test
investigations
laparoscope
Page | 77
Internal ring
iliac fossa lumbar region testis

canal
testis Internal ring

canal canal
testis
vanishing testis
Intra uterine torsion
Investigations
isotope scan
MRI
laparoscope ultra sound

Investigations
IVP
Ultra sound
Laparoscope
IVP
Urinary congenital anomalies Undescended testis 13.5 %
IVP Laparoscope ultra sound
Undescended testis
bilateral unilateral
Unilateral
Surgical
bilateral
hormonal
Undescended testis
bilateral Unilateral
Page | 78
Unilateral
mechanical unilateral
hormonal bilateral
Hormonal therapy
surgical failed
surgical Mechanical Unilateral

hormonal failed hormonal hormonal bilateral
Hormonal therapy bilateral

testosterone Human chrionic gonadotrophins
HCG
testis testosterone
epiphysis
testosterone HCG hormone
failed hormonal therapy
subside edema

Hormonal
testosterone HCG
failed horomonal therapy

surgical
Page | 79
unilateral
Hormonal therapy surgery
surgery
testis cord
testis cord
cord
Undescended testis
cord Mainly
cord
testis
target
cord
testis
cord
cord external spermatic fascia
testis
external speramtic fascia

testis
cremastric muscle
Page | 80
testis
internal spermatic fascia
cord
testis
testicular artery vas

testis
vas
testicular artery
testicular artery
vas
vas
vas
testicular artery
nutrition of the testis
artery of the vas
artery of the vas
artery of the vas vas testis
90 %
10 %
Page | 81
gangrene
artery of the vas

testis 10 %
Inferior epigastric testicular artery

Inferior epigastric artery testicular artery
blood supply
Additional blood supply

auto transplanation
testicular artery
abdominal aorta testicular artery
abdomen embryo testis

blood supply
abdominal aorta L2 testicular artery
testicular artery
testicular artery
testicular artery
proximal part of the artery abdominal aorta
distal part of the testicular artery testis
auto transplantation
distal of testicular artery proximal of testicular artery
Inferior epigastric artery proximal part of the testicular artery
inferior epigastric artery testicular artery abdominal aorta
inferior epigastric artery distal of the testicular artery

testis distal part of the testicular artery
testicular artery Inferior epigastric artery testis
Page | 82
testis
testis blood supply
artery of the vas testicular artery

Fowler -Steven technique
Fowler - Steven
artery of the vas testicular artery

testicular atrophy
testicular atrophy
Steven
testis testicular artery
testis auto transplantation
testicular atrophy 10 %
Undescended testis
Unilateral
bilateral
bilateral
Hormonal
Beta HCG 500 U intra muscular
failed
surgery
Unilateral
surgical
surgery
Page | 83
Elongation of the cord

Orchiopexy testis
cord Elongation
elongation of the cord

Fowler - Steven
testis
testis
scrotum
scrotum

scrotum
scrotum
testis
testis
testis within the

to heal
fibrosis
testis
Dartos pouch
Dartos pouch
Dartos muscle scrotum
Dartos pouch
Page | 84
fibrosis testis
testis fibrosis
fibrous tissue testis

Dartos pouch
scrotum testis
scrotum testis
Dartos pouch
septum scrotum
septum
testis
testis
testis
septum
Dartos pouch
retractile testis
retractile testis
scrotum
testis
37.5
Page | 85
scrotum
35 scrotum
testis
external ring
37.5
Inguinal canal
external ring testis
testis
external ring scrotum
testis
testis testis
cremastric muscle
testis cremastric muscle
cremastric
testis
Page | 86
cremastric muscle

retractile testis
scrotum testis
testis
squatting
testis
Torsion of the testis

testis

There is no torsion on top of normal testis
there is no torsion on top of normal testis
Page | 87
Normal testis
Hidden congenital anomaly

scrotum testis
scrotum
spiral cremastric muscle
Normal testis cremastric muscle

spiral cremastric
spiral cremastric muscle
scrotum
cremastric muscle
spirally arranged
risk
hidden congenital anomaly
bilateral lesion
testis
testis
Page | 88
bilateral congenital anomaly
bilateral Hidden congenital anomaly

testis torsion
bilateral Lesion
spirally arranged cremastric muscle
tunica vaginalis scrotum testis

scrotum tunica vaginalis
High up
Like clapper in a bell testis
scrotum
testis
tunica vaginalis
scrotum testis
scrotum

tunica testis
Hidden congenital anomaly
back
Page | 89

Predisposing factor
Exciting factor
congenital anomaly predisposing factor

exciting factor
inversion
Posteriorly epididymis
Upper pole of the testis
Polar inversion
tunica epididymis
tunica congenital anomaly epididymis congenital anomaly
Mesorchium
congenital anomaly testis
Mesentery epididymis
Ovary mesovarium Mesorchium
congenital anomaly
epididymis testis
Mesentery
resistant for eduction redundent Loose testis
Spirally arranged cremastric muscle

High investment of tunica vaginalis
Mesorchium
Polar invesrion
undescended testis

severe Pain
pain
Page | 90
vomiting neasuea Palpitation sweating

Autonomic manifestations
torsion
epididymo-orchitis
epididymo-orchitis
genito urinary
urinary tract infection
epididymo-orchitis

epididymo-orchitis
urinary tract infection back
epididymis
back Pain
epididymo-orchitis clinical pictures

history of urinary tract infection epididymo-orchitis clinical pictures
pain rigor fever
sudden torsion
torsion of the testis local examination
cord
testis
Page | 91
scrotum
cord
twist
testis
Twist
scrotum
scrotum
epididymo-orchitis pain
torsion of the testis pain
Pain congestion
scrotum
scrotum
torsion
Local examination
cord
testis
scrotum
twist cord
High up : testis
elevation of the scrotum scrotum
Page | 92
investigations
Duppler
torsion
Surgery
surgery
orchiopexy Untwist
gangernous testis
19
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Page | 93

Liver and Testis

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Liver and Testis

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Liver & Testis Revision Dr.

Hydatid Disease of the liver

cyst Inter mediate host

blind end of life cycle

accidental inter mediate host

accidental inter mediate host

blind end Life cycle

parasite laminated layer

Parasite laminated layer

Broad capsule Scolices

Parasite germinal layer

cyst cyst germinal layer

laminated layer trauma

Under tension cyst

accidental intermediate host

blind end of life cycle

Immune system adventitia

small amounts of protein

small amounts of protein

common bile duct Scolices common bile duct ( CBD )

common bile duct

pleural effusion Liver cyst

sympathy Pleural effusion sub phernic abscess

Serology CT scan diagnosis

serology ultra sound

Indirect haemagglutination complement fixation

Indirect haemagglutination complement fixation

common bile duct Hydatid cyst Hydatid cyst

complications Hydatid cyst

surgery sandwiched in medical treatment treatment

laminated layer adventitia

cyst under tension

Double way syringe

cyst under tension

surgery medical treatment

Amoebic liver Abscess

Host parasite relationship

host parasite relationship

cysts stool analysis

host parasite relationship

Entamobea blood vessel

Entamoeba blood vessel

blood vessel Entamoeba

blood vessel Liver

rabbit coco nut

Coalesce amoebic hepatitis

Irregular chaggy amoebic liver abscess wall

false abscess amoebic liver abscess

not a true abscess amoebic live abscess

true abscess amoebic liver abscess

amoebic liver abscess is not a true abscess

Liver amoebic liver abscess

complications amoebic liver abscess

Cyst, hemorrhage, rupture, infection, pressure and calcification

common bile duct amoebic liver abscess

Hydatid cyst amoebic liver abscess

amoebic liver abscess

Acute cholecystitis but, major pain and minimal fever

radiating to the right shoulder right hypochondrium Pain

rebound tenderness regidity

Major pain and minimal fever

amoebic liver abscess

Normal gall bladder

normal gall bladder sonar