Abdomen clinical medicine case scenario

Details of abdominal pathology

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

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

3. 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. 4
Jaundice (J+)
•Surgical √
–Itching
–Clay colored stool
–Se Alkaline Phosphatase 
–Direct bilirubin 
–Total Bilirubin 

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

6. 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. 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. 8
Distractors
1.CA gall bladder
2.CBD stone
3.Hilar cholangiocarcinoma
4.CA head of pancreas
5.Biliary agenesis

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

10. 10
J+
•GB  Hard

11. 11
J+
•GB  Hard = CA GB

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

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

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

15. 15
J+
•GB Not palpable
•No pain

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

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

18. 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)

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

20. 20
J+
•Hard liver- smooth

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

22. 22
J+
•Liver Hard- nodular

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

24. 24
J+
•Pain +
•Fever +

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

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

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

28. 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

29. 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. 30
GB Stone : Types
•? Examine Spleen in GB

31. 31
Appendix
•No mass= Appendicectomy

32. 32
Appendix
•Mass but normal temp= Conservative

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

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

35. 35
Colorectal Cancer
•Commonest symptom
•Inv

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

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