Download 100 cases in surgery by James Gossage, Bijan Modarai, Arun Sahai, Richard Worth PDF

By James Gossage, Bijan Modarai, Arun Sahai, Richard Worth

The purpose of the a hundred instances sequence is to supply a unique studying and revision software that works by means of guiding the reader via medical circumstances, imitating those who scholars and junior medical professionals are inclined to meet in twist of fate and emergency and outpatient departments, and in most cases perform.

100 circumstances in Surgery offers a hundred surgical situations regularly obvious and handled via scientific scholars and junior medical professionals. The patient's background, exam and preliminary research effects are awarded along questions about the prognosis and administration of every case. the reply features a certain dialogue on each one subject offering a necessary revision reduction for college kids and junior doctors.

Making medical judgements is without doubt one of the so much difficult and hard components of educating to turn into a physician. those situations will train scholars and junior medical professionals to know very important surgical stipulations and support them strengthen their diagnostic and administration skills.

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Questions • • • • What is the diagnosis? What are the characteristics of this anomaly? How can this present? How would you deal with this intraoperative finding? 19 100 Cases in Surgery ANSWER 10 The photograph demonstrates a Meckel’s diverticulum located on the anti-mesenteric border of a segment of ileum. This is a remnant of the omphalomesenteric duct. e. it is present in 2 per cent of the population, it is 2 inches long and located 2 feet from the ileocaecal valve. A Meckel’s diverticulum may be lined by small-intestinal, colonic or gastric mucosa, and it may contain aberrant pancreatic tissue.

Colonoscopy can be used to decompress the bowel and may resolve the volvulus. Urgent laparotomy will be required if decompression is not possible or in cases of suspected gangrene/ perforation (fever, leucocytosis, peritonism, free air under the diaphragm on erect chest radiography). The patient’s fitness for surgery, prognosis and quality of life should be considered before proceeding to laparotomy. It may be appropriate to use only conservative treatments in some patients. Sigmoid volvulus is predisposed to by a long, narrow mesocolon and chronic constipation.

1. 1 Plain x-ray of the abdomen. Questions • What is the likely diagnosis? • 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.

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