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RIGHT ILIAC FOSSA MASS-DDS & INVESTIGATIONS

RIGHT ILIAC FOSSA MASS-DDS & INVESTIGATIONS. BY ZIYANA LIYAKATH 2002 BATCH. ILIAC FOSSA REGION-ANATOMYY. TOPOGRAPHY OF RIF. Swellings in RIF. PARIETAL rare except iliac abscess/appendicular abscess burrow through anterior abdominal wall & may become parietal INTRA ABDOMINAL Two types

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RIGHT ILIAC FOSSA MASS-DDS & INVESTIGATIONS

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  1. RIGHT ILIAC FOSSA MASS-DDS & INVESTIGATIONS BY ZIYANA LIYAKATH 2002 BATCH

  2. ILIAC FOSSA REGION-ANATOMYY

  3. TOPOGRAPHY OF RIF

  4. Swellings in RIF • PARIETAL • rare except iliac abscess/appendicular abscess burrow through anterior abdominal wall & may become parietal • INTRA ABDOMINAL • Two types • Structures normally present in the site • Structures abnormally invade region

  5. NORMALLY PRESENT • APPENDIX • CAECUM • TERMINAL PART OF ILEUM • LYMPH NODES • ILIAC ARTERIES • RETROPERITONEAL CONNECTIVE TISSUE Gross

  6. ILIOPSOAS SHEATH • ILIUM

  7. ABNORMALLY INVADE • RENAL SWELLING • GALL BLADDER SWELLING • UTERINE SWELLING • URINARY VESICAL • UNASCENDED TESTIS • PELVIC ABSCESS

  8. APPENDIX

  9. ANATOMY • Average length:7.5-10 c.m • Position->retrocaecal(44%),pelvic(21%),subcaecal(1.5%),postileal(.5%),paracaecal(2%),preileal(1%) • Histology->mucosa,sub mucosa,muscularis propria,serosa • Mesentry->meso appendix • Blood supply->appendicular artery,acessory appendicular

  10. Position of appendix

  11. APPENDICULAR MASS • Third day or earlier after attack of appendicitis • At the position of appendix • O/E->irregular firm tender & fixed mass • Rigidity of abdominal musculature • Tympanitic on percussion • CONSTITUENTS • Inflamed appendix • Greater omentum • Oedematous caecal wall • .coils of small intestine

  12. APPENDICULAR ABSCESS • Failure of resolution of appendix mass • Continued spiking pyrexia

  13. RARE • MUCOCELE • When proximal end of lumen slowly becomes completely occluded by fibrotic stricture & retained sterile secretions ,appendix enlarged greatly & sometimes contains several milli litres of mucus • When infection supervenes empyema develops

  14. Mucocele appendix

  15. NEOPLASMS • CARCINOID TUMOUR[ARGENTAFFINOMA] • Arise from argentaffin tissue[kulchitsky cells of crypts of lieberkuhn],most commonly in vermiform appendix • 10 times more common • Frequently distal 3rd • Feels hard

  16. Carcinoid tumour

  17. CARCINOMA CAECUM • Patient above 40 • Hard fixed lump • May not be any change in bowl habit if present alternate constipation & diarrhoea • Anemia,anorexia,weight loss

  18. AMOEBIC CAECAL MASS • Entamoeba Histolytica • Tenderness on deep palpation over caecum & sigmoid

  19. ACTINOMYCOSIS • Hard & fixed mass • Multiple sinuses seen discharging sulphur granules • Discoloration of affected skin

  20. TERMINAL ILEUM • IMPACTION OF ROUND WORMS • Lower part of ileum • History of passing worm with stools/vomitus

  21. CROHN’S DISEASE • CLINICAL FEATURES • INFLAMATORY STAGE • Tender mass • Fever • Anemia • Diarrhoea • COLITIS STAGE

  22. Diarrhoea,fever,anemia,loss of weight,occult blood & mucus present in stool • Steatorrhoea • Fissure in ano • Perianal abcess • Anal fistula • STENOTIC STAGE • Small intestinal obstruction

  23. FISTULA • External/internal

  24. CROHN’S DISEASE

  25. ILEOCAECAL REGION • HYPERPLASTIC ILEOCAECAL TB • Injection of mycobacterium TB.Infection starts in lymphoid follicles &then spreads to submucous & subserous planes • Intestinal wall thickened,lumen narrowed • Matted lymphnodes+terminal part of ileum & caecum involvement produced lump

  26. Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix

  27. COMPLAINTS • 1.Recurrent attacks of abdominal pain with diarrhoea • 2.Blind loop syndrome • 3.lump • 4.general

  28. GIBBUS OF SPINE

  29. LYMPH NODES • Enlargment of iliac group of lymphnodes • A.FILARIAL • Periodic attacks of fever with simultaneous tenderness & swelling of nodes

  30. B.TUBERCULOUS LYMPH NODE • GENERAL FEATURES • Matted lymph nodes

  31. C.LYMPHOSARCOMA • Rapid enlargment of nodes • Young subject • D.SECONDARY CARCINOMA • Other evidence of primary ca • Usually old

  32. ANEURYSM OF ILIAC ARTERIES • RARE

  33. ILIOPSOAS SHEATH • ILIAC ABSCESS • Infection of haematoma in iliacus muscle • Pain,tenderness restricted to region • Clear space btw abscess&ilium

  34. TENDER POINT OF ILIACUS

  35. PSOAS ABSCESS • Down the thoracolumbar vertebra to pelvis&crosses inguinal ligament to thigh • Cross fluctuation present

  36. ABSCESS IN THE THIGH

  37. ILIUM • Bony swelling

  38. ABNORMALLY INVADING • 1.KIDNEY • A.PELVIC KIDNEY • The first rudiment appear in pelvis • With development ascend to final position • Due to unknown reasons kidney fail; to ascend & remains permanently in pelvis/right iliac fossa • B.DROPPED/MOVABLE KIDNEY • Extremely rare

  39. GALL BLADDER SWELLING • Hugely distended gall bladder with enlarged liver descend as low as right iliac fossa

  40. UTERINE & IT’S APPENDAGE

  41. h/o vaginal discharge • Menstrual irregularities • p/v can confirm clinically • A.tubo-ovarian mass • B.pyosalpinx • C,.cyst & abscess of broad ligament • D.fibroid of uterus • E.ovarian cyst

  42. UNDESCENDED TESTIS • Develops in lumbar region • As foetus grows,testis descends through inguinal canal into scrotum • Fails to descend • Commonest-superficial ing pouch

  43. PELVIC ABSCESS • Most common presentation-spiking pyrexia • Pelvic pressure/discomfort associated with loose stool,tenesmus • P/R->Boggy tender mass in pelvis anterior to rectum

  44. INVESTIGATION

  45. 1.ROUTINE BLOOD • A.ANEMIA-malignancy,tuberculosis,crohn’s disease • B.ESR-malignancy,tuberculosis,crohn’s disease

  46. C.POLYMORPHONUCLEAR LEUCOCYTOSIS • D.EOSINOPHILIA • E.MICROFILARIAE

  47. MICROFILARIAE

  48. EOSINOPPHILIA

  49. 2.URINE • UTI • RBCs • 3.STOOL • Occult blood • microscopy

  50. 4.TUBERCULOUS ETIOLOGY • Psoas abscess,ileocaecal T.B,lymphnode • AFB STAIN • C & S • LUMBAR X-RAY,DORSAL SPINE X-RAY

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