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Abdomen

Abdomen. Professor Ravi Kant MS FRCS (Edin) FRCS (Glasg) FAMS FACS DNB FICS FAIS. MCQ. Short story = clinical vignette One line question 5 options= distractors One will be correct Blue print. Blue print. 10 basics = trauma 10 H&N 10 Breast 10 hernia, etc 10 jaundice, abdomen

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Abdomen

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  1. Abdomen Professor Ravi Kant MS FRCS (Edin) FRCS (Glasg) FAMS FACS DNB FICS FAIS

  2. MCQ • Short story = clinical vignette • One line question • 5 options= distractors • One will be correct • Blue print

  3. Blue print • 10 basics = trauma • 10 H&N • 10 Breast • 10 hernia, etc • 10 jaundice, abdomen • 10 abdomen • 10 colo-rectal • 10 Ped surgery • 5 vascular • 5 Thoracic • 10 Plastic surgery

  4. Jaundice (J+) • Surgical √ • Itching • Clay colored stool • Se Alkaline Phosphatase  • Direct bilirubin  • Total Bilirubin 

  5. J+ • If GB  = NOT a case of CBD STONE • Courvoisier’s law • = palpable

  6. J+ • GB  Soft • A 45 y old male presents to OPD with jaundice, clay colored stools, itching. On examination, soft gall bladder is palpable. Total and direct bilirubin is raised.

  7. A 45 y old male presents to OPD with jaundice, clay colored stools, itching. On examination, soft gall bladder is palpable. Total and direct bilirubin is raised. • Which of the following is the likely diagnosis?

  8. Distractors • CA gall bladder • CBD stone • Hilar cholangiocarcinoma • CA head of pancreas • Biliary agenesis

  9. J+ • GB  Soft= CA head of Pancreas of CA Periampullary (D or B or P)

  10. J+ • GB  Hard

  11. J+ • GB  Hard = CA GB

  12. GB  Soft = CA Head of Pancreas or CA Periampullary GB  Hard = CA GB J+

  13. J+ • GB Not palpable • Pain present • = ?

  14. J+ • GB Not palpable • Pain present • Young • = CBD Stone • Courvoisier’s law

  15. J+ • GB Not palpable • No pain

  16. J+ • GB Not palpable • No pain = • Hilar Cholangiocarcinoma (Klatskin’s tumor) • Intra-hepatic • Congenital

  17. J+ • 2 months age • GB Not palpable • No pain = • Intra-hepatic • = Biliary agenesis= Kasai operation

  18. GB not palpable Pain + CBD stone Inv MRCP Rx ERCP GB not palpable Pain – Hilar Cholangiocarcinoma Inv MRCP Rx Excision + H-J (Hepatico-jejunostomy) J+

  19. Congenital Syndromes • Dubin Johnson • Gilbert • Rotor • Criggler Najjar

  20. J+ • Hard liver- smooth

  21. J+ • Hard liver- smooth • = Primary Carcinoma of Liver • Inv =AFP, CT scan, MRA • FNAC is CONTRAINDICATED • Rx = Surgery= Resection

  22. J+ • Liver Hard- nodular

  23. J+ • Liver Hard- nodular • = Secondaries in Liver • Inv = search for primary= P0 • FNAC Liver (if PT is N)

  24. J+ • Pain + • Fever +

  25. J+ • Pain + • Fever + = Charcot’s triad =Surgical emergency = IV fluids, antibiotics ►Later, when stabilized, Inv MRCP ; Rx ERCP

  26. Triad • Hiatus hernia • Cholelithiais • Diverticulosis • = Saint’s triad

  27. Liver ▲ • Hydatid • Amoebic- pain & thump sign present • Tumors- primary & Secondary

  28. RIF mass : DD • Appendicular • CA Caecum • Ileo-caecal TB • Crohn’s • Actinomycosis • Carcinoid • Amoeboma • LN mass

  29. Appendicular CA Caecum Ileo-caecal TB Crohn’s Actnomycosis Carcinoid Amoeboma LN mass Undescended testis Ectopic kidney In F= TO Mass Aneurysm of Iliac Art Bone tumour RIF mass : DD

  30. GB Stone : Types • ? Examine Spleen in GB

  31. Appendix • No mass= Appendicectomy

  32. Appendix • Mass but normal temp= Conservative

  33. Appendix • Mass but  temp= Abscess= Image guided aspiration

  34. Colorectal Cancer • Anal • Rectal • Rectosigmoid • Premalignant • Inv & Rx

  35. Colorectal Cancer • Commonest symptom • Inv

  36. LIF Mass DD • Diverticulosis • Rectosigmoid CA • LN • TO- mass--- CA 125

  37. Types, Inv & Rx of • Hemorrhoids • Fistula in Ano • Fissure in Ano

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