1. MS FRCS (Edin) FRCS (Glasg) FAMS FACS DNB FICS FAIS
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+) Itching Clay colored stool Se Alkaline Phosphatase 
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. J+ GB  Soft = CA Head of Pancreas or CA Periampullary GB  Hard
= CA GB

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

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. 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

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