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2 The mechanism of testicular descent through the inguinal canal (a), and obliteration of the processus vaginalis (b). Incomplete obliteration leads to an encysted hydrocele (c), a scrotal hydrocele (d), an incomplete hernia (e), or a complete hernia (inguinoscrotal hernia) (f) a Inguinoscrotal Lesions b Proximal processus obliterated Testis and processus descending into gubernacular mesenchyme c Encysted hydrocele d e Hydrocele the more common situation, only the proximal processus remains patent and the hernia presents as a lump at the external ring.

Persistence of either vomiting or diarrhoea should make one suspicious of alternative diagnoses, of which appendicitis is one. Constipation Poor diet, a constitutional predisposition and poor bowel training may all contribute to constipation. Often, there is a history suggestive of an anal fissure: acute anal pain on defecation and small amounts of fresh red blood of the surface of the stool or on the toilet paper. In other children, there is a long history of infrequent passage of hard bowel actions over a long period.

During the drive to hospital, the child may complain that every time the car goes over a bump the pain is made worse. Contraction of the diaphragm causes the abdominal wall to move with respiration. Such movement is painful in peritonitis, and the child will use the chest wall muscles in breathing to a greater degree in an effort to keep the abdomen still. This is assisted by tonic contraction of the abdominal wall muscles which, in a thin child, is seen as prominence of the rectus abdominis muscles at rest in an abdomen which moves little with respiration.

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Batman - Time Thaw


by Charles
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