By James Gossage, Bijan Modarai, Arun Sahai, Richard Worth
The purpose of the a hundred circumstances sequence is to supply a singular studying and revision device that works via guiding the reader via medical instances, imitating those who scholars and junior medical professionals are inclined to meet in coincidence and emergency and outpatient departments, and generally perform.
100 instances in Surgery offers a hundred surgical situations mostly noticeable and handled by means of scientific scholars and junior medical professionals. The patient's historical past, exam and preliminary research effects are awarded along questions about the analysis and administration of every case. the reply features a special dialogue on each one subject supplying an important revision relief for college kids and junior doctors.
Making medical judgements is among the so much not easy and hard components of educating to turn into a physician. those situations will train scholars and junior medical professionals to understand very important surgical stipulations and support them increase their diagnostic and administration skills.
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What are the possible causes? • Which further investigations are required? 29 100 Cases in Surgery ANSWER 15 The x-ray demonstrates large-bowel obstruction. Large-bowel obstruction classically presents with lower abdominal pain, abdominal distension and absolute constipation. Vomiting is a late feature. The common causes of large-bowel obstruction are listed below: • Carcinoma: approximately 15 per cent of colorectal cancers present with obstruction and roughly 25 per cent are found to have distant metastases at the time of presentation • Diverticulitis: repeated episodes of diverticulitis can lead to fibrosis and narrowing of the colonic lumen • Volvulus: sigmoid volvulus typically occurs in older individuals with a history of constipation and straining, whereas caecal volvulus is seen in younger patients and is associated with a congenital defect in the peritoneum, resulting in inadequate fixation of the caecum • Intussusception: intussusception is most commonly seen in children; approximately 70 per cent of adult intussusceptions are caused by tumours • Colonic pseudo-obstruction: pseudo-obstruction or Ogilvie syndrome is seen most often in the elderly patient with chronic or severe illness In approximately 20 per cent of patients, the ileocaecal valve is competent resulting in a ‘closed-loop’ obstruction which does not allow decompression into the small bowel.
Ulcers situated on the anterior duodenal wall perforate into the abdominal cavity, resulting in free intraperitoneal gas. Posteriorly, ulcers erode into the gastroduodenal artery, which is more likely to result in bleeding. Common causes of a pneumoperitoneum • Ruptured hollow viscus: perforated peptic ulcer or diverticulum, necrotizing enterocolitis, toxic megacolon, inflammatory bowel disease • Infection: infection of the peritoneal cavity with gas-forming organisms and/or rupture of an adjacent abscess • Iatrogenic factors: recent abdominal surgery, abdominal trauma, a leaking surgical anastomosis, misplaced chest drain, endoscopic perforation It is important to be sure that the chest x-ray is taken in the erect position.
What are the indications for surgery? 39 100 Cases in Surgery ANSWER 19 Increasing frequency of stool, anorexia, low-grade fever, abdominal tenderness and anaemia suggest an inflammatory bowel disease. The histological findings are characteristic of Crohn’s disease. g. enteroenteric, enterovesical, enteroureteric, enterocutaneous • Uncontrollable haemorrhage (rare) ! Extra-intestinal manifestations of Crohn’s • Conjunctivitis and iritis • Cirrhosis of the liver • Cholangiocarcinoma • Primary sclerosing cholangitis • Renal stones and gallstones • Erythema nodosum • Pyoderma gangrenosum • Psoriasis • Ankylosing spondylitis Potent anti-inflammatory drugs are the mainstay of medical therapy.