Abdomen Professor Ravi Kant MS FRCS Edin FRCS

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

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

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

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

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

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. 6

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? 7

Distractors 1. 2. 3. 4. 5. CA gall bladder CBD stone Hilar cholangiocarcinoma CA head of pancreas Biliary agenesis 8

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

J+ • GB Hard 10

J+ • GB Hard = CA GB 11

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

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

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

J+ • GB Not palpable • No pain 15

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

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

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

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

J+ • Hard liver- smooth 20

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

J+ • Liver Hard- nodular 22

J+ • Liver Hard- nodular • = Secondaries in Liver • Inv = search for primary= P 0 • FNAC Liver (if PT is N) 23

J+ • Pain + • Fever + 24

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

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

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

RIF mass : DD 1. 2. 3. 4. 5. 6. 7. 8. Appendicular CA Caecum Ileo-caecal TB Crohn’s Actinomycosis Carcinoid Amoeboma LN mass 28

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 29

GB Stone : Types • ? Examine Spleen in GB 30

Appendix • No mass= Appendicectomy 31

Appendix • Mass but normal temp= Conservative 32

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

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

Colorectal Cancer • Commonest symptom • Inv 35

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

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