Kidney Stones

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Kidney stones, a condition called nephrolithiasis, occur at any of the anatomical restriction points in the ureter:

  • ureter-pelvic junction
  • pelvic brim
  • bladder entrance

Treatment: extracorporal shock wave lithotripsy (ECSW) treatment can be used to break up the stones and allow the patient to pass them with less pain. Severe cases may require surgery.

Indirect Inguinal Hernia

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  • Most common inguinal hernia
  • Leave abdominal cavity lateral to the inferior epigastric vessels
  • Transverses the deep inguinal ring, inguinal canal and superficial inguinal ring

Direct Inguinal Hernia

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  • Protrude anteriorly through the posterior wall of the inguinal canal
  • Leave the abdominal cavity medial to the inferior epigastric vessels
  • Passes through the inguinal triangle (Hesselbach’s triangle)

Hesselbach’s triangle is located posteriorly to the superficial inguinal ring and is bounded by:

  • inguinal ligament (inferior)
  • inferior epigastric vessels (lateral)
  • rectus abdominus (medial)

Transverse Pericardial Sinus

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Located behind the aorta and pulmonary trunk and in front of LA & SVC.

Surgically important during bypass procedures. A digit and ligature can be passed through the transverse sinus between the great arteries and the pulmonary trunk.


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Pleura is surgically removed. To prevent recurrent spontaneous pneumothorax, the pleural poudrage procedure may be utilized where irritating agents are injected and cover the opposing surfaces.

Basic Chest Wall Incisions


Thoracocentesis=surgical puncture of the chest wall.

Thoracostomy=incision made in the chest wall to drain fluids. Needle thoracostomy utilizes a medial/lateral approach. Tube thoracostomy inserts at ICS 4 or ICS 5 at the anterior axillary line.

Thoracotomy=extreme surgical procedure. Uses incision on chest wall over ICS 4 or ICS 5. Goal is emergency access of thoracic organs.