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Published byBennett Harvey Dorsey Modified over 9 years ago
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1 Abdomen Professor Ravi Kant MS FRCS (Edin) FRCS (Glasg) FAMS FACS DNB FICS FAIS
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2 MCQ Short story = clinical vignette One line question 5 options= distractors One will be correct Blue print
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3 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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4 Jaundice (J+) Surgical √ –Itching –Clay colored stool –Se Alkaline Phosphatase –Direct bilirubin –Total Bilirubin
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5 J+ If GB = NOT a case of CBD STONE Courvoisier’s law = palpable
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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.
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7 Which of the following is the likely diagnosis?
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8 Distractors 1.CA gall bladder 2.CBD stone 3.Hilar cholangiocarcinoma 4.CA head of pancreas 5.Biliary agenesis
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9 J+ GB Soft= CA head of Pancreas of CA Periampullary (D or B or P)
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10 J+ GB Hard
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11 J+ GB Hard = CA GB
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12 J+ GB Soft = CA Head of Pancreas or CA Periampullary GB Hard = CA GB
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13 J+ GB Not palpable Pain present = ?
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14 J+ GB Not palpable Pain present Young = CBD Stone Courvoisier’s law
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15 J+ GB Not palpable No pain
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16 J+ GB Not palpable No pain = Hilar Cholangiocarcinoma (Klatskin’s tumor) Intra-hepatic Congenital
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17 J+ 2 months age GB Not palpable No pain = Intra-hepatic = Biliary agenesis= Kasai operation
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18 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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19 Congenital Syndromes Dubin Johnson Gilbert Rotor Criggler Najjar
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20 J+ Hard liver- smooth
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21 J+ Hard liver- smooth = Primary Carcinoma of Liver Inv =AFP, CT scan, MRA FNAC is CONTRAINDICATED Rx = Surgery= Resection
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22 J+ Liver Hard- nodular
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23 J+ Liver Hard- nodular = Secondaries in Liver Inv = search for primary= P 0 FNAC Liver (if PT is N)
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24 J+ Pain + Fever +
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25 J+ Pain + Fever + = Charcot’s triad =Surgical emergency = IV fluids, antibiotics ►Later, when stabilized, Inv MRCP ; Rx ERCP
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26 Triad Hiatus hernia Cholelithiais Diverticulosis = Saint’s triad
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27 Liver ▲ Hydatid Amoebic- pain & thump sign present Tumors- primary & Secondary
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28 RIF mass : DD 1.Appendicular 2.CA Caecum 3.Ileo-caecal TB 4.Crohn’s 5.Actinomycosis 6.Carcinoid 7.Amoeboma 8.LN mass
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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
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30 GB Stone : Types ? Examine Spleen in GB
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31 Appendix No mass= Appendicectomy
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32 Appendix Mass but normal temp= Conservative
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33 Appendix Mass but temp= Abscess= Image guided aspiration
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34 Colorectal Cancer Anal Rectal Rectosigmoid Premalignant Inv & Rx
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35 Colorectal Cancer Commonest symptom Inv
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36 LIF Mass DD Diverticulosis Rectosigmoid CA LN TO- mass--- CA 125
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37 Types, Inv & Rx of Hemorrhoids Fistula in Ano Fissure in Ano
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