CYSTS, ULCERS & SINUSES.ppt

cysts , ulcers , sinuses

1. ميحرلا نمحرلا الله مسب
” املع ىندز بر لقو“

2. DR IMRANA AZIZ
Assistant Professor
Surgical Department

3. CYSTS
&
ULCERS

4. CYSTS
•Cyst is a fluid filled sac bound by a wall.
•Fluid is often clear, colorless or
cholesterol crystals, or tooth paste like.
•True Cyst: lined with epithelial or
endothelial cells.
•False Cyst: which are walled off fluid
collection not by epithelium
e.g. Pancreatic pseudocyst

5. Classification
Congenital
Acquired

6. CONGENITAL
CYSTS
•Sequestration dermoid
•Tubuloembryonic
•Cysts of embryonic remnants
–Hydatid of Morgagni
–Cysts of the urachus
–Cyst of vitellointestinal duct
–Cysts of wolffian duct
•Branchial Cyst
•Thyroglossal Cyst

7. ACQUIRED
CYSTS
•Retention cysts
•Cystic tumours
•Implantation dermoids
•Traumatic cysts
•Degeneration
•Parasitic cysts
–Hydatid,
–trichniasis,
–cysticercosis

8. •Sequestration dermoid:
•This is due to dermal cell being buried
along to the lines of closure of embryonic
clefts and sinuses by skin fusion.
•Lined by epidermis and containing paste
like material.
•Sites midline of body
• outer canthus
• anterior triangle of mouth.

9. •Tubuloembryonic cyst:
• in the track of ectodermal
tube development.
•e.g: thyroglossal cyst, ependymal
cyst.

10. •Acquired cyst:
•Retention cyst:
•due to accumulation of secretion in
gland behind an obstruction of a
duct.
•e.g: sebaceous cyst, Pseudu
pancreatic cyst, parotid gland cyst.

11. •Distension cyst:
•occur in thyroid from dilatation of
acni.
•cystic hygroma and lymphatic
cyst.

12. Exudation Cyst
•Exudative fluid accumulate in
endothelium lined anatomical space.
•e.g: Hydrocele, bursa.

13. Cystic tumor
•e.g: cystic teratoma, cystadenoma.
Implantation dermoid
•Squamous epithelium driven beneath
skin by penetrating wound.

14. Clinical Features
•Varies according to the site & size
•Pain →enlarging cysts,
•Pain →Secondary to haemorrhage,
infection, rupture, torsion
•Acute abdominal emergency: torsion
or rupture of ovarian cyst

15. Clinical Features
Compression symptoms resulting from
compression of adjacent structures
Haemorrhage in thyroglossal cyst →
increase in size →compress the
trachea
Large ovarian cyst →abd: fullness &
reduced appetite resulting from raises
I/abd: pressure
Obstruction to pelvic veins →varicose
veins of lower limbs

16. COMPLICATIONS
1.Infection
2.Haemorrhage
3.Torsion
4.Obstruction
5.Calcification
6.Malignancy ( very rarely)

17. INVESTIGATIONS
Signs: Fluctuant, transilluminant if
containing clear fluid
Diagnosis: obvious in cases of superficial
cysts
Deep seated intra-abdominal or thoracic
cysts need U/sound, CT scan, MRI

18. Page No. 14

19. Page No. 14

21. Page No. 196

22. Page No. 209

24. ULCER
•An ulcer is a break in the continuity
of an epithelial surface.
•Characterized by progressive
destruction of the surface epithelium
and a granulating base which may
clean, healthy or containing necrotic
slough

25. Clinical Examination
•Size
•Shape
•Edge
•Floor
•Base
•Discharge
•Surrounding area
•Lymph nodes
•Pain
•General exam:
•Pathological exam:

28. Marjolin’s ulcer
•Malignant change occurring in any
long standing benign ulcer
irrespective of its cause.
•Change usually occurs at the edge of
a chronic ulcer

29. Management
•Treatment of cause
•Accurate assessment of the ulcer
•Identify & correct the co -morbid factors
•Adequate drainage & desloughing
•Antiseptics and topical antibiotics
•Wound dressings
–Hydrogel
–Alginates
–Lyofoam
–Tegaderm
–Alleyvn

30. Page No. 08

31. Page No. 07

32. Page No. 176

33. Page No. 173

34. SINUSES
•A sinus is a blind tract usually lined
with granulation tissue that leads
from an epithelial surface into the
surrounding tissue.
•e.g. pilonidal sinus

35. FISTULA
•Itisacommunicatingtrackbetween
twoepithelialsurfaces,commonly
betweenahollowviscusandtheskin
(externalfistula)orbetweentwo
hollowviscera(internalfistula)
•Thetrackislinedwithgranulation
tissuewhichissubsequently
epithelialzed

37. CLASSIFICATION
Congenital
Acquired

38. Pathological sinuses
•CONGENITAL
1. Preauricular
2. Umbilical
3. Urachal
4. Coccygeal
5. Sacral
•ACQUIRED
1. Pilonidal
2. Suture
3. Post-surgical
4. Actinomycosis
5. Tuberculosis
6. Osteomyelitis

39. Persistence of a sinus or fistula
•F Foreign Body & Necrotic Tissue
•R Radiation
•I Immunosupression
Infection
Ischemia
•E Epithelization
•N Neoplasia
•D Drugs (eg: Steroids , Cytotoxic drugs)
Distal Obstruction
•S Systemic Diseases (eg: AIDS)

40. Clinical features
•Asymptomatic
•Recurrent or persistent discharge
•Pain
•Infection

41. Diagnosis
•Assess the accurate direction, depth
& presence of multiple tracts.
•Microbiological examination of
discharge ( gut organism, actinomycosis,
tuberculosis)
•Sinogram

42. Management of Sinus
•Complete excision of all sinus tract.
•Sinus is laid open or excised
•Biopsy of tissue is sent
•Removal of the cause