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Abdomen
Professor Ravi KantMS FRCS (Edin) FRCS (Glasg) FAMS FACS
DNB FICS FAIS
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MCQ
• Short story = clinical vignette
• One line question
• 5 options= distractors
• One will be correct
• Blue print
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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
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Jaundice (J+)
• Surgical √
–Itching
–Clay colored stool
–Se Alkaline Phosphatase –Direct bilirubin –Total Bilirubin
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J+
• If GB = NOT a case of CBD STONE
• Courvoisier’s law
= palpable
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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.
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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?
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Distractors
1. CA gall bladder
2. CBD stone
3. Hilar cholangiocarcinoma
4. CA head of pancreas
5. Biliary agenesis
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J+
• GB Soft= CA head of Pancreas of CA Periampullary (D or B or P)
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J+
• GB Hard
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J+
• GB Hard = CA GB
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J+
• GB Soft
= CA Head of Pancreas
or
• CA Periampullary
• GB Hard
= CA GB
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J+
• GB Not palpable
• Pain present
• = ?
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J+
• GB Not palpable
• Pain present
• Young
• = CBD Stone
• Courvoisier’s law
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J+
• GB Not palpable
• No pain
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J+
• GB Not palpable
• No pain
=
• Hilar Cholangiocarcinoma (Klatskin’s tumor)
• Intra-hepatic
• Congenital
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J+
• 2 months age
• GB Not palpable
• No pain =
• Intra-hepatic
• = Biliary agenesis= Kasai operation
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J+
• GB not palpable
• Pain +
• CBD stone
• Inv MRCP
• Rx ERCP
• GB not palpable
• Pain –
• Hilar Cholangiocarcinoma
• Inv MRCP
• Rx Excision + H-J• (Hepatico-jejunostomy)
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Congenital Syndromes
• Dubin Johnson
• Gilbert
• Rotor
• Criggler Najjar
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J+
• Hard liver- smooth
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J+
• Hard liver- smooth
• = Primary Carcinoma of Liver
• Inv =AFP, CT scan, MRA
• FNAC is CONTRAINDICATED
• Rx = Surgery= Resection
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J+
• Liver Hard- nodular
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J+
• Liver Hard- nodular
• = Secondaries in Liver
• Inv = search for primary= P0
• FNAC Liver (if PT is N)
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J+
• Pain +
• Fever +
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J+
• Pain +• Fever += Charcot’s triad=Surgical emergency= IV fluids, antibiotics►Later, when stabilized, Inv MRCP ; Rx ERCP
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Triad
• Hiatus hernia
• Cholelithiais
• Diverticulosis
• = Saint’s triad
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Liver ▲
• Hydatid
• Amoebic- pain & thump sign present
• Tumors- primary & Secondary
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RIF mass : DD
1. Appendicular2. CA Caecum3. Ileo-caecal TB4. Crohn’s5. Actinomycosis6. Carcinoid7. Amoeboma8. LN mass
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RIF mass : DD
• 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
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GB Stone : Types
• ? Examine Spleen in GB
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Appendix
• No mass= Appendicectomy
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Appendix
• Mass but normal temp= Conservative
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Appendix
• Mass but temp= Abscess= Image guided aspiration
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Colorectal Cancer
• Anal
• Rectal
• Rectosigmoid
• Premalignant
• Inv & Rx
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Colorectal Cancer
• Commonest symptom
• Inv
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LIF Mass DD
• Diverticulosis
• Rectosigmoid CA
• LN
• TO- mass--- CA 125
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Types, Inv & Rx of
• Hemorrhoids
• Fistula in Ano
• Fissure in Ano
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