SURGERY CHANTING BY DR.

PARAS
SURGICAL TRAUMA

DISASTER MX

SIMPLE TRIAGE EMG . SEVERITY INDEX

BY PARA MEDICAL BY DOCTOR
→
staff . →
→ DONE AT SITE OF → AT HOSPITAL
DISASTER

☆ 1042° ASSESSMENT = AT HOSPITAL

→ f. ASSESSMENT → AIRWAY BREATHING ,

CIRCULATION
,
+ SCORING
→ 2° ASSESSMENT → Hx TAKING 1- EXAMINATION

☆ SCORING SYSTEM

•
TRISS -
TRAUMA INJURY SEVERITY SCORE
↳ AGE -1 ISS 1- RTS

↳ISS → INJURY SCORE [ ANATOMICAL SCORING]

SEVERITY
↳ RTS → REVISED TRAUMA SCORE C. PHYSIOLOGICAL SCORING]
•
SBP + RR -1 Gcs
☆ TRIAGE
RED Sx NEEDED
→ IMMEDIATELY
YELLOW → SX NEEDED C- IN 6 Web -1 #
GREEN → AMBULATORY PT. CAN WAIT
BLACK → PULSE LESS
☆ HEAD TRAUMA → Ixoc -
NCCT

•
ANTCRANIAL FOSA #
.

→ # PART = CRIBRIFORM PLATE

→ CIF CSF RHINORRHOEA
= .

RACOON EYES /PANDA EYE

•

•
MIDDLE CRANIAL FOSA #
→ # PART = PETROUS PART -

OF TEMPORAL BONE
→ CIF = •
CSF OTORRHEA
•
BATTLE SIGN

• EDH = EXTRA DURAL HEMATOMA

→ INJURY = MIDDLE MENINGEAL ARTERY
→ MOST IMP FEATURE = LUCID INTERVAL
→ IOC = NET SCAN

•
SDH =
SUB DURAL HEMATOMA
→ INJURY = BRIDGING VEIN
→ Ioc = NCCT SCAN

•
MANAGMENT =

→ ↓ ICP
→ ↑ CEREBRAL PERFUSION PRESSURE
RX → MEDICAL SURGICAL
•
MANNITOL ↳ IF ICP IS NOT ↓
•
IVF =
NS + RL • BURR HOLES
• BLOOD PLATELETS ppp
g
,
☆ FACE TRAUMA .

•
UPPER FACE → LEFORT # Ig # , #
• LOWER FACE → MC -

MANDIBULAR A-

Ioc → ORTHOPENTAMOGRAM
•

•
RX → OPEN REDUCTION & INTERNAL FIXATION
C- PLATES & SCREWS

☆ NECK TRAUMA

A> BLUNT TRAUMA

•
INJ . TO CERVICAL SPINE
RX → IMMOBLIZATION C- CERVICAL COLLAR

B) PENETRATING TRAUMA
SHOCK INDEX __PULI
•
ZONE # SBP
'

ZONE # >I
'

•
MC -20N 9 =
=
HEMODYNAMIC ALLY
•
ZONE I =MC DANGEROUS TONE UNSTABLE

RX
UNSTABLE MEMODYNAMICALLY STABLE
SX EXPLORATION OF IX -1 NON OPERATIVE
PROCEDURE
.
☆ CHEST TRAUMA
=ttL > R
"

MC SITE RIB

A> PNEUMOTHORAX
B) MEMO THORAX

1ˢᵗ Ix →
•
X-RAY
•
Ixoc → CT -
SCAN

•
RX>TUBE THORACOTOMY [4m / 5M INTERCOSTAL SPACE -

MID AXILLARY LINE ]

c) TENSION PNEUMOTHORAX

→ MASSIVE AIR TRAPPED

→ IPSILATERAL LUNG COLLAPSE
→ ME DISTINAL SHIFT

RX → IMMEDIATE NEEDLE THORACOCENTESIS -149 NEEDLE

SITE → ADULT SMICS AXILLARY LINE

CHILDREN→→
MID
,
zndzcs MID CTLAVKULAR LINE
,

D) FLIAL CHEST
•
22 CONSECUTIVE RIB # AT 72 SITES

RX → ANALGESICS 1- 02 + POSITIVE PRESSURE VENTILATION

☆ ABDOMINAL TRAUMA =

MC INJURY IN BLUNT TRUMA = SPLEEN

MC INJURY IN PENETRATING RUMA = LIVER

Ix -
FAST -
FOCUSSED ASSESSMENT BY SONOGRAPHY
,

IN TRAUMA
RHC
'

→ -
LIVER + R KIDNEY
→ LHC -
SPLEEN + L KIDNEY
→
EPIGASTRIUM -

PERICARDIAL CAVITY
→
PELVIS -
FREE FLUID IN PERITONEAL CAVITY

BEST Ix → CECT ABDOMEN

I
•
MC ZONE TO GET INSURED = ZONE -

RX → HEMODYNAMIC ALLEY STABLE → OBSERVATION

HEMODYNAMIC ALLY UNSTABLE> LAPAROTOMY

☆ HYPOVOLEMIC SHOCK
=
MCC OF DEATH IN TRAUMA
•
1St EARLIEST SIGN → TACHYCARDIA
•
EARLY SIGN → CUTANEOUS VASOCONSTRICTION
•
LATE → VASODILATION

Rx → •
ABC •
DIRECT CONT
.
BLEEDING
•
IVF
• BLOOD PLATELETS FFP
,
,
☆ HAEMORRHAGE

•
BLOOD LOSS CATEGORIES
I -
O -

15%
I -

15-30 %
#
-
30 -40%
II -
740%

☆ THERMAL BURNS

•
MC -
DAY TO DAY -
SCALD [ NOT LIQUID]
•
me -
HOSPITAL
-

FLAME BURNS

→ MC SOURCE OF INFECTION - PSEUDOMONAS

→ TOTAL BODY SURFACE AREA IN BURN PT

↳ MC IN ADULT = WALLACE RULE

↳ MC IN CHILDREN =
LUND & BROWDER CHARTS

→ DEPTH OF BURN

1° → EPIDERMIS
2°→ EPIDERMIS + DERMIS
3°→ EPIDERMIS 1- DERMIS -1
SUBCUTANEOUS FAT
4° → EPIDERMIS + DERMIS + SUBCUTANEOUS FAT -1
MUSCLE
 → MANAGMENT

I • 1St → ABC
2 •
IF AIRWAY BURN →INSERT ETT
3.• FLUID OF CHOICE → RINGER LACTATE SOLUTION
↓
* ATLS FORMULA =

↳ ADULT → 2X % BORN ✗ wtckgs) 42in 1ˢᵗ 8 hrs

↳ CHILDREN → 3. ✗ % Burn ✗ wtckgg)
WTCRGD 121N hrs
✗ NEXT 16
↳ ELECTRICAL → UX % BURN ✗

PARKLAND'S FORMULA Wtckgs]

* =
UX % BURN ✗

4. SKIN GRAFTING

→ AUTO GRAFT → SAME PERSON

→ ISO GRAFT → IDENTICAL TWIN
→ ALLO GRAFT → SAME SPECIES
→ XENO GRAFT → DIFF RENT SPECIES

↳ INSTRUMENT =
HUMBY 'S KNIFE WOLFE 'S BLADE
g

•
PARTIAL THICKNESS SKIN GRAFT
↳ EPIDERMIS DERMIS
1- SUB
↳ MC DONOR SITE THIGH -

• FULL THICKNESS SKIN GRAFT

↳ EPIDERMIS 1- COMPLETE DERMIS
↳ me SITE
POST AURICULAR
-
→MCC OF IMMEDIATE DEATH → HYPOXIA C.SUFFOCATION )
→
mec OF EARLY DEATH → HYPOVOLEMIA
→ MCC OF LATE DEATH → SEPSIS

☆ CHEMICAL BURN =

ACID → COAGULATION NECROSIS

ALKALI → LIQUEFACTIVE NECROSIS [MOST DANGEROUS]

Rx → IRRIGATION C- RUNNING WATER

☆ COLD BURN

A> FROST BITE

B> TRENCH FOOT

Rx → REWARMING WITH WATER

ANALGESIA
SURGERY

☆ CLASSIFICATION OF SURGICAL WOUNDS

I → CLEAN -

NO INFECTION
# → CLEAN CONTAMINATED -
MINIMAL INFECTION
# → CONTAMINATED _ SIGNIFICANT INFECTION
☒ → DIRTY GROSS -
INFECTION
☆ KELOID AND HYPERTROPHIC SCAR

FEATURES HYPERTROPHIC SCAR KELOID

MARGIN LIMITED EXTENDED

SITE ANYWHERE STERNUM SMOLDER

• ,
EAR LOBULE
RACE NOT SPECIFIC BEACH AFRO 'S

RX MASSAGE C- CREAM INTRA KELOIDAL INS .

OF TRIAMCINOLONE
VASCULAR SURGERY

☆ GRADUAL ARTERIAL OBSTRUCTION

•
Mcc -

ATHEROSCLEROSIS
BURGER 'S DISEASE
-

I -

ATHEROSCLEROSIS
C
/F -
INTERMITTENT CLAUDICATION
[ PAIN ON CALF MUSCLE ON WALKING]
BOYD 'S GRADING FOR INTERMITTENT CLAUDICATION
-
GANGRENE

CLINICAL EXAMINATION
-

→ Exm .
OF PULSE → POPLITEAL → MOST DIFF .
To FEEL

→ DORSALIS PEDIS → 1ˢᵗ METATARSAL SPACE

MAN AUMENT
→ AIM = ↑ BLOOD SUPPLY TO RELIEVE SYMPTOM

1. LSM → ⊖ SMOKING + NWT .

[ LIFE STYLE MODIFICATION]

2. MEDICAL RX → VASODILATOR
ANTI PLATELETS

3. FOGARTY CATHETER IN VASCULAR SX .

4. Sx BYPASS GRAFT BEST VEIN

-
AREAS SPHENOUS
-
-
II BURGER 'S /
DISEASE Th ROMBOANGITYS OBLITERANS

→ Mcc =
SMOKING
→ INVOLVE ARTERY , VEIN , NERVE BUT NEVER -
LYMPHATICS

CIF -
REST PAIN
RX - •
NO CIGARETTES
•

MEDICAL RX
•
LUMBAR SYMPATHECTOMY → TO RELIEVE REST PAIN

HI RAYNAUD 'S DISEASE =

SPASM OF ARTERIOLE ON COLD EXPOSURE

GENDER = FEMALE
PULSE =
NORMAL
1° Rod = NOT ASSOCIATED C- OTHER DISEASE
2° R D.
=
ASSOCIATED C- SLE , R A etc
.

RAYNAUD 'S PHENOMENON

WHITE →
BLUE → RED

RX → •
LIFE STYLE MODIFICATION
•
MEDICAL Rx -
CCBS
,
NITRATES
☆ SUDDEN ARTERIAL OBSTRUCTION =
EMBOLISM

→ SUDDEN OCCLUSION OF VESSEL BY SUBSTANCE

CIF =
PAINPALLOR PULSELESS
,, ,
PARASTMESIA ,
POIKILOTHERM A

RX = 1St _ LOW MOL . Wt .

HEPARIN [TO ]
PREVENT EXTENSION

I
THROMBOLYSIS BY TPA STREPTOKINASE , UROKINASE
g

☆ VARICOSE VEIN =

→ SUPERFICIAL VEINS ARE DILATED & TORTUOUS

MCC = VALVULAR INCOMPETENCE → SAPHENO FEMORAL VALVE

RIF = PROLONGED .

STANDING
PREGNANCY
PELVIC TUMOR
DEEP VEIN THROMBOSIS

IN VALVULAR INCOMPETENCE
↓
BLOOD WILL MOVE FROM → ACHING DISCOMFORT
DEEP TO SUP . VEIN
 COMPLICATION =
VENOUS ULCER .

↓
MARIO LIN 9s ULCER
&
CELL CARCINOMA
Sq .

CLINICAL TEST =

• BRODIE TRENDELENBURG TEST → FOR VALVULAR INCOMPETENCE

•
FEGAN, S TEST → FOR PERFORATOR INCOMPETENCE

IOC = DUPLEX IMAGING

↓
IN SAPHENO FEMORAL INCOMPETENCE -- MICKY MOUSE SIGN

Rx = EARLY LATE

•
LIFESTYLE MODIFICATION •
SCLEROTHERAPY
•
AVOID PROLONGED STANDING SXI.oTRENDELENB.ORG Op .

•
LIMB {VENATION •
SUBFASCIAL ENDOSCOPIC
•
ELASTIC COMPRESSION STOCKING .
PERFORATOR SXESEPS]
☆ DEEP VEIN THROMBOSIS

MC SITE -

CALF VEINS
MCC
-
PROLONGED IMMOBKISATION
VIRCHOW D →
ENDOTHELIAL INJURY
→ STASIS
→ HYPERCOAGULABIUTY
CIF -
HOMAN 'S SIGN [RESISTANCE TO DORSI FLEXION ]
MOSES SIGN [CALF PAIN ON SQUEEZING CALF ]
MUSCLE

IOC -
DUPLEX IMAGING
TEST -
PERTHES TEST
Rx -
LOW MOLECULAR Wt . HEPARIN
↓
ORAL WARFARIN
FOR RECURRENT DVT -
IVC FILTER

.
ENDOCRINE SURGERY
☆ GOITER
→ ENLARGEMENT OF THYROID GLAND
Mcc -

Iz DEFICIENCY
1. DIFFUSE GOITER → REVERSIBLE c- IODINE / THYROXINE
2. NODULAR GOITER → IRREVERSIBLE

→
SIS → PRESSURE SYMPTOM DYSPONEA DYSPHAGIA
-

,
→
COMPLICATION → 2° THYROTOXICOSIS
→ FOLLICULAR THYROID CANCER
→ a / ex → US -
Neck
→ US GUIDED FNAC

Rx → HEMI THRO / DECTOMY

¢ NEAR TOTAL

THYROIDECTOMY

②J TOTAL

[ SUBTOTAL
THYROID ECTOMY
TMYROIDECTOMY

☆ BREAST
→ -

MODIFIED SWEAT GLAND

→ MC -

SITE OF BREAST CANCER → Upp

. OUTER QUADRANT
CONGENITAL CONDITION
AMAZIA → -
nt BREAST ATHENA → nt NIPPLE-

POLYMAZIA > MULTIPLE BREAST POLYTHELIA → MULTIPLE NIPPLE

 1. MASTITIS

→ Mcc - STAPH AUREUS ( BABY MOUTH]

→ other CAUSE -
PREGNANCY LACTATION
,
→ Rx -
Ab .tt BREAST SUPPORT

↓ IF ABSCESS DEVELOP

Abt -1 INCISION & DRAINAGE

☆ NIPPLE
DISCHARGE FROM
→ me MILK
Disch ARE -

→ MC PATHOLOGICAL DISCHARGE SEROUS -

→ MCC OF GREEN DISCHARGE DUCT ECT ASIA

-

→ MCC OF BLOOD DISCHARGE DUCT PAPILLOMA

-

2. DUCT ECTASIA
→ MCC GREEN
OF DISCHARGE SMOKING & ALCOHOL
=

→ MULTIPLE DUCTS ARE INVOLVED

'
-
-

→ ABNORMAL DILATION OF LECTIFEROUS DUCT SEEN

RX > PLENTY OF FLUIDS + BREAST MASSAGE
↓
MICRO DOCH OTOMY ( Excision OF SINGLE LECTIFEROUS DUCT]
&
HADFIELD 9s OPERATION (EXCISION OF MULTIPLE LECTIFEROUS
]
DUCT
3. DUCT PAPILLOMA
→ MCC OF BLOODY DISCHARGE FROM NIPPLE
→ ABNORMAL PAPILLARY GROWTH FROM LACTIFEROUS DUCT

RX -
MICRODOCHECTOMY C.SINGLE DUCT)
↓
HADFIELD OPERATION (MULTIPLE DUCT]

MC BENIGN BREAST TUMOR -

FIBRO ADENOMA
MC BENIGN BEAST TUMOR 230 YB -
FIBROADENOMA
MC BENIGN BREAST TUMOR>308s INVASIVE Brca-

4. FIBRO ADENOMA [ BREAST MOUSE]

→ BENIGN TUMOR
→ HYPERPLASIA OF INTRALOBULAR STROMA

→ me
off → BREAST LUMP [FREE & MOBILE]

→ Ix → c- CLINICAL
R -

RADIOLOGICAL → MAMMOGRAM POPCORN

=

P -
PATHOLOGICAL → WELL DEFINE CAPSULE

→ Rx -
IF SIZE LESS -

CONSERVATIVE MX .

IF SIZE ↑ -

EXCISION
5. CYSTOSARCOMA PHYLLODES [PHYLLODES TUMOR]

→ HYPERPLASIA OF STROMA
Rx → WIDE LOCAL EXCISION

6. BREAST CANCER
→ OVERALL me CANCER IN
-
WORLD

→ GENE ASSOCIATED -

BRCA -
l

BRCA -2

C
/F- B- BREAST LUMP
D- DIMPLING OF SKIN
p PEAUDE ORANGE App
-

↳ DUE TO BLOCKAGE OF SUB DERMAL LYMPHATICS

SPREAD → BLOOD -
LUMBAR VERTEBRA
LYMPHATICS AXILLARY L N
-
.

CL .

App _ CLINICAL -

4×4 PM EX . .

RADIO -
US
, MAMMOGRAPHY

PATH 0 -
BIOPSY -
FNAC CIXOD
 PEDIATRIC SURGERY
I. CLEFT LIP & PALATE

RIF -
GENETIC
DRUG INTAKE -
PHENYTOIN DIAZEPAM
,

PROBLEM -

BREATHING DIFFICULTY SPEECH DIFFICULTY

,

Rx -

PLASTIC RECONSTRUCTION

2. THYROGLOSSAL CYST

→
ACCUMULATION OF SECRETION IN THYROGLOSSAL
TRACT

CIP -
SWELLING MOVES C-DEGLUT / NATION +
PROTRUSION OF TONGUE

COMPLICATION -
THYROGLOSSAL FISTULA
PAPILLARY THYROID CANCER

Rx -
SISTRUNK OPERATION
.

[ EXCISION OF CYST -1 EXCISION OF TMYROGLOSSAL

TRACT]
3. CYSTIC HYIGROMA

→ LYMPHATIC FLUID INSIDE

LYMPHATIC SACK

Clinical TEST -
TRANS ILLUMINATION TEST
+ve

RX - SCLEROTHERAPY
COMPLETE EXCISION

4- ESOPHAGEAL ATRESIA I

→ ABSENCE OF SOME PART OF ESOPHAGUS

TYPE =

11.11
BLINDED
MC TYPE = C → • UPPER ESOPHAGUS
•
LOWER ESOPHAGUS COMMUNICATE
C- TRACHEA

IX -

COILING OF NG TUBE
3×0 C- CT SCAN
MC -

PRESENTATION -
CONT / NOUS POURING OF
SLIVA FROM MOUTH
Rx -
ESO -

ESOPUAGESTOMY

☆ DYSPHAGIA LUSORIA =

COMPRESSION OF ESOPHAGUS BY ⑨ SUBCLAVIAN ARTERY

5. ABDOMINAL ATRESIA

SBS -
PYLORIC ATRESIA
DBS -
DUODENAL ATRESIA
ANNULAR PANCREAS
TBS -
JEJUNAL ATRESIA
MBS -
PERFORATION

Rx Duodo Dud
ostomy
-
-
.

08

DUODO -
JEJUNOSTOMY

6. CHPS -
CONGENITAL HYPERTROPHIC PYLORIC STENOSIS

→ HYPERTROPHY OF PYLORIC MUSCLE

→ PRESENT DURING 3rd WEEK OF LIFE [ 2-6th WEEK]

C) F -

OLIVE LUMP IN EPIGASTRIUM

-
PROJECTILE NON BILIOUS VOMITING
-

METABOLIC ALKALOSIS

Ix -
US ABDOMEN -
THICK PYLORIC MASS 63-4min

Rx 1St REHYDRATE
Emergency
- -

↓
INITIAL Rx PNEUMATIC BALOON DILATATION
-

↓
TOC RAMSTED-19s RYLOROSEROMYOTOMY
-
7. BILIARY ATRESIA -

→ ABSENCE OF BILIARY CHANNELS

TYPES = I ② CBD Rx - =
HEPATIC 0 JEJUNOSTOMY
II ② CHD
II ② RHD & LHD]R✗= KASAI OPERATION

C F- / JAUNDICE → Ix -
LFT

Ixoc -
HIDA SCAN

8. CHOLEDOCHAL CYST
CYSTIC DILATION OF BILIARY CHANNEL

1- YES -
TODANI CLASSIFICATION -- I -

TYPES
→I
,
#
•
II → CBD
→I gI
→ HEPATIC DUCTS

Rx -
OPD EMERGENCY

→ PAINLESS JAUNDICE + → CHARCOT'S TRIAD

MASS IN Rnc → REYNOLD'S PENTAD
↓ &
Ixoc -
ERCP Ixoc -
ERCP
& ↓
Rx -

CYSTIC EXCISION Rx IN FLUID -1 ANTIBIOTIC

-

c- HEPA -10 - I
JEJUNOSTOMY ERCP -1 ENDOBIUARY STENTING
 9. INTUSSUSCEPTION

→ TELESCOPING OF INTESTINE
MC -

SITE ILEOCOLIC JUNCTION

-

F- SAVAGE SHAPE LUMP

RED CURRENT JELLY STOOLS
-

Ix -
Us -
Abdomen → DOUGHNUT SIGN
✗ -

RAY Ba ENEMA →
-

. CLAW SIGN
COILED SPRING SIGN
Rx -
HYDROSTATC REDUCTION - AIR ENEMA
↓
REDUCTION & END TO END ANASTOMOSIS

10 POLYCYSTIC KIDNEY DISEASE

. =

→ A. D A. R
,
→ MULTIPLE CYST DEVELOP IN KIDNEY
→ BIL CONDITION

Ixoc -
CECT ABDOMEN
zvp → SPIDER LEG APPERANCE

Rx → INITIAL -
DE ROOFING OF CYST
&
RENAL TRANSPLANT
II. HORSE SHOE KIDNEY =

→ FUSION OF 2 LOBES OF KIDNEY

-
Me SITE = 13 -24
-

BEST IX -

CECT
IVP -

FLOWER VASE APP .

Rx -

DIVISION OF 2 KIDNEYS

12 MECKEL'S DIVERTICULUM

→ ALL LAYERS OF INTESTINE ARE OUT

RULE OF 2 =
↳ 2cm WIDE
↳ 2inches LONG
↳ 2 FEET FROM ILEOCAECAL JUNCTION
↳ PRESENTS AT AROUND 2 YRS OF AGE

IF MECKEL 'S FOUND IN HERNIA SAC → LITTER 'S HERNIA

COMPLICATION -
BLEEDING ULCER INTUSSUSCEPTION
, , ,

IOC -

MECKEL 'S SCAN [ BARIUM MEAL FOLLOW THROUGH

Rx -

IF ASYMPTOMATIC → NO RX .

IF SYMPTOMATIC → RESECTION & ANASTOMOSIS

 13 HIRSCHSPRUNG
.
'S DISEASE [ MEGA -
COLON ]

→ ABSENCE OF GANGLION CELLS IN NERVE PLEXUS

MC -

SITE =
RECTO -

SIGMOID

IOC -
SUCTION RECTAL BIOPSY
IOC FOR EXTENT OF DISEASE -
Ba ENEMA
.

RX -
DUHAMEL OPERATION
SWENSON 'S OPERATION
14 URETEROCELE
.

BALOONING AT THE END OF URETER INSIDE THE

BLADDER
IVU ADDER MEAD / COBRA HEAD
-

Rx -

ENDOSCOPIC LONGITUDINAL
INCISION OF URETER / C ORIFICE

COMPLICATION OF SX -
VURCVESKO URETERK REFLUX]
IOC -
MCU CMICTURATING URETHROGRAM]

15 .
POSTERIOR URETHERA VALVES

IOC -
MCU
Rx -
TRANS URETHRAL RESECTION OF VALVES
16 . HYPOSPADIAS

→ MC -

CONG ANOMALY OF MALE

URETHERA

SITE = MC -1 LEAST SEVERE GLANDULAR

-

LEAST COMMON -1 MORE SEVERE -

PERINEAL

Rx -

URETHROPLASTY C 6-18 months]

CIRCUMCISION → c. I 1N HYPOSPADIAS

17 UNDESTENDED TESTIS CUDT)

→ me CONG . ANOMALY OF MALE GENITALIA

→ ARREST IN ⑨ PATH → MC SITE -

INGUINAL CANAL

COMPLICATION -

ATROPHY TRAUMA STERILITY

, g
TORSION INGUINAL HERNIA me , .

Ix
-

Usa ABDOMEN 1- SCROTOM

-
DIAGNOSTIC LAPAROSCOPY

Rx -

ORCHIDOPEXY ( 6-12 MONTH]

A MCC OR TESTICULAR MALIGNANCY - UDT

[ SEMI NOMA]
ADULT SURGERY
☆ ACHALASIA CARD / A

→ FAILURE OF RELAXATION OF LES

MC
HF → DYSPHAGIA LIQUIDS .TO SOLIDS
-

REGURGITATION

C/ App .
→ BARIUM SWALLOW -

BIRD BEAK
Sign .

STANDARD Ix → ESOPHAGEAL MANOMETRY [ 25-100

mmHg]
Rx → DRUG 's → CCB 'S
,
NITRATES
Sx → POEM -
PER ORAL ENDOSCOPIC MYOTOMY

☆ GERD -
GASTRO ESO .
REFLUX DISEASE

→ ④ LES RELAX -
3-4 TIMES IN 24 hrs .

RIF -
SMOKING
,
ALCOHOL g TEA ,
COFFEE ETC

MC
CIF -

HEART BURN -1 EPIGASTRIC PAIN + REGURGITATION

IX -
24hr AMBULATORY ph MONITORING
JOHNSON DE MEESTER SCORE -
GOLD SEND . Ix
<4 FOR > 4 TIMES 24 hrs
pls IN
.

RX -
LIFE STYLE MODIFICATION .

PPI
Floppy NISSEN 'S FUNDO PLICATION
COMPLICATION OF GERD -
BARRE -19s ESOPHAGUS
SLIDING HIATUS HERNIA

☆ BARRET 'S ESOPHAGUS

→ INTESTINAL COLUMN AL METAPLASIA OF SQUAMOUS

MUCOSA OF LOWER ESOPHAGUS

HALLMARK - GOBLET CELLS

Rx PPI
-

RESECTION OF LOWER ESOPHAGUS & GASTRIC

PULL UP OPERATION
-

PARA -
ESO -
Hn
☆ HIATUS HERNIA -
ROLLING HH
SLIDING HH GIANT HH

GE JUNCTION
-
THORAX ABDOMEN
REFLUX ✓ ✗
EIF CHEST PAIN CHEST PAIN
'

DYSPNOEA DYSPNOEA
IOC CECT CEET
RX FUNDO PLICATION FUNDO PLICATION

BAUM

EoeoeooEcEBoooEA☆eMoy
☆ BOERHAAVE SYNDROME

→ SPOTANEOUS ESOPHAGEAL PERFORATION

RIF -
HEAVY MEALS
,
BINGE DRINKING

MC -

SITE -
LEFT
,
LOWER
,
POSTEROLATERAL WALL

GF → ② CHEST PAIN RADIATING TO ② SHOULDER

,
② ARM

→ SUBCUTANEOUS EMPHYSEMA

MACKLER'S TRID -

VOMITING
CHEST PAIN
SUBCUTANEOUS EMPHYSEMA

ON AUSCULTATION -
MEDIASTINAL CRUNCH /
HAMMAN 'S SIGN

1St Ix → CXR PNEUMO MEDIASTINUM

-

Ioc → CT SCAN GASTRO GRAFFIN ( Wos CONTRAST]

- -

Rx → < 4- 6 hrs → MINIMAL CONTAMINATION

CLOSURE OF PERFORATION
> 4- 6 hrs → GROSS CONTAMINATION
LEAVE A DRAIN
 ☆ IATROGENIC ESOPHAGEAL PERFORATION

MCC -
ENDOSCOPY
MCSITE -
NEAR CRICOPMARYNX
Rx -
LEAVE NG TUBE FOR 5-7 DAYS

☆ FOREIGN BODIES IN ESOPHAGUS

MC -

CHILD -
COIN
ADULT -
FOOD
ELDERLY -
LOOSE TEETH DENTURES
,

Rx -
IF ASYMPTOMATIC -
MESMY FOOD
IF SYMPTOMATIC -
ENDOSCOPIC REMOVAL

☆ ACUTE GASTRITIS -

RIF -
NSAID 'S SMOKING
, ,
H PYLORI
.

MC -
CIF -
HEMATEMESIS

MCC OF MEMATEMESIS - PEPTIC ULCER

MALLORY WEISS TEAR
ESO -
VARICES
Ix - UPEER G. I ENDOSCOPY
Mx - I. V -

FLUIDS
IF 730% B. L -
BLOOD TRANSFUSION
LIGATE BLEEDING VESSEL
 r

& MALLORY WEISS TEAR -

LONGITUDINAL TEAR IN GASTRIC MUCOSA

RIF -
ALCOHOL
MC -
SITE -
CARDIA OF STOMACH
RX
-

COLD SALINE WASH

☆ ESOPHAGEAL VARICES

→ VEIN
ABNORMAL DILATATION OF

* CHRONIC GASTRITIS

↳TYPE A
'
-

AUTOIMMUNE GASTRITIS

ETIOLOGY -
Ab -
AGAINST PARIETAL CELL
↓
↓ IF
↓
PERNICIOUS ANEMIA

↳ TYPE B. GASTRITIS -
H PYLORI
.

EX CLO TEST ERADICATION

]
- IF the →
UREA BREATH TEST THERAPY
 ☆ PEPTIC ULCER -

MC -

ARTERY GASTRO DUODENAL ARTERY

-

MC SITE DI
-
HEAD INJURY CUSHING ULCER
-

MCC -
H PYLORI
. BURN CURLING ULCER
-

SMOKING .

SPICES
SYNDROME -
ZOLLINGER ELLISON SYNDROME

DUODENAL ULCER GASTRIC ULCER

AGE YOUNG ELDERLY

SOCIO ECNOMIC RICH POOR
PATHOGENESIS ↑ HCL DISRUPTION OF
GASTRIC MUCUS BARRIER .

GF EPIGASTRIC PAIN EPIGASTRIC PAIN

PAIN RELATED 2-3 hrs AFTER MEALS IMMEDIATELY AFTER

TO MEALS MEALS

PAIN RELIEVED FOOD VOMITING

BY

TOC PPI PPI

SX HIGH SELECTIVE ROUX en YGJ

VAUOTOMY [GASTRO JEJUNOSTOMY]
COMPLICATION OF SURGERY FOR PEPTIC ULCER

1. POST DIARRHOEA
VAGOTOMY
2. VIT -

B12 DEFICIENCY
3. DUMPING SYNDROME

]
↳ EARY → ↑ BLOOD TO INTESTINE Rx SMALL -

↳ LATE → REACTIVE HYPOGLYCEMIA FREQUENT MEALS

☆ BEZOARS

TRICHOBEZOR -
HAIR
PHYTOBEZOR -

VEGETABLE
LACTO BEZOR -
MILK PRODUCTS

☆ BARIATRIC SURGERY = SX FOR MORBID OBESITY

INDICATION -
BMI = > 35 -1 COMORBIDITIES

MOST EFFECTIVE Sx -
ROUX enY GASTRIC BYPASS
☆ GALL STONE CHOLE LITHIASIS
-

TYPES -

1. CHOLESTEROL -
PALE YELLOW COLOUR
SEEN IN -
FAT FERTILE FEMALE
, ,
OF FORTY
2. PIGMENT -
GREEN BROWN
,
3. MIXED -
GREY

RX -
IF ASYMPTOMATIC → NO RX

IF OPD EMERGENCY

→ MILD PAIN + DISCOMFORT → LARGE STONE OBSTRUCTING

↓ THE MOUTH OF GALLBLADDER
Ixoc -
US ABDOMEN
-

↓
↓ CIF •
SUDDEN SEVERE RHC
PAIN RADIATING TO ⑨
Rx -
LAPROSCOPIC TIP OF SCAPULA
CHOLECYSTECTOMY • ANOREXIA q
NAUSEA
&
EXAM → CLINICAL
MURPHY 'S SIGN
↓
Ixoc us ABDOMEN - -

* NOTE HIDA SCAN

-
IS Ixoc TO DIFF ACUTE .

CHOLECYSTITIS & A CALCULUS CNOLESCYSTOPATMY

↓
 ↓
Rx -
CONSERVATIVE
IVF + IV Ab 5- 7- DAYS
&
DISCHARGE ADVICE
INTERVAL CHOLECYSTECTOMY
AFTER 3- 6 WEEKS

☆ GALL BLADDER PATHOLOGIES →

1. MUCOCELE
→ MUCUS DISTENTION OF GB

2. CH LESTEROSIS
-

STRAWBERRY GB -
Yellow FLAKES ON MUCOSAL
SURFACE OF GB

3. PORCELAIN GB -

→ CALCIUM DEPOSITION IN GB → ↑ RISK OF CANCER

4. MIR 1221 'S SYNDROME -

→ JAUNDICE D) T COMPRESSION OF CHD BY

A LARGE GALL STONE
5- FISTULA OF GB =

MC -
SITE - 1ˢᵗ PART OF DUODENUM

GALLSTONE → SLIPS INTO DUODENUM → BLOCK

DISTAL ILEUM
X-RAY -

RIGGLAR 'S TRIAD

→ MULTIPLE AIR FLUID LEVELS
→ AIR IN GB
→ STONE IN INTESTINE

Rx - REMOVAL OF OBSTRUCTION

☆ CNOLEDOCMO LITHIASIS [ STONE IN ]

COMMON BILE DUCT

DIT → SLIPPAGE OF GS → CBD

OPD EMERGENCY
↓ → CHARCOT TRIAD -
PTF -1J
INTERMITTENT JAUNDICE ↓
& → Basic RESUS IVF Iv -
Ab
,
HᵗI✗ -
US ABDOMEN -14=-1 &
IOC -
ERCP Ix US ABDOMEN 1- LFT
↓ &
Rx -
ERCP -1 SPHINCTER oeomy Rx -
ERCP -1 STEWING
1- DORM / A BASKET .

CBD STONE EXTRACTION

☆ ACUTE PACREATITIS
→ ACUTE INFLAMATIONOF PANCREAS
→ ↑ PANCREATIC ENZYMES LIPASE -

MCC -
GALL STONE > ALCOHOL

C. P - •
SUDDEN SEVERE UPPER Abd . PAIN RADIATING
TO THE BACK
•
PT SITTING IN MOM PRAYER
.
POSITION

C. / F- RETROPERITONEUM BLEED

D- → FLANKS → GREY TURNER SIGN

B. → UMBILICUS → CULLENS SIGN

SHOCK
-

TACHYCARDIA g TACHYPNOEA ,
HYPOTENSION

Rx -
Iv FLUID 1- CALCIUM
☆ CHRONIC PANCREATITIS

MCC -
ALCOHOL > GALLSTONE

Clp -

PAIN EPIGASTRIUM ↑ AFTER MEALS

-

MALABSORPTION BCZ OF CACLIFICATION

DM
IX -

MRCP / ERCP -
CHAIN OF LAKES APP .

RX -

MALABSORPTION → PANC . ENZYME SUPPLIMENT

Dm → INSULIN
PAIN → ANALGESICS
☆ LIVER ABSCESS
PYOGENYC AMOEBIC HYDATID CYST

STREP-10 MILLER ENTAMOEBA ECHINOCOCCUS

.

}
E. COL, HISTOLYTICA GRANULOSA

Rx PENICILLIN RX METRONIDAZOLE RX ALBENDAZOLE

-

METRONIDAZOLE
SX US GUIDED PER SX - PERCUTANEOUS
SX US GUIDED CUTANEOUS CATH . ASPIRATION
PERCUTANEOUS DRAINAGE

[ 1)
DRAINAGE ACHOVY SAUCE
CHOCOLATE PUS
☆ URINARY STONES

→ mc KIDNEY STONE → Ca OXALATE DIHYDRATE

→ MC UB STONE → MALE CHILD 1-RIPPLE PHOSPHATE
-

ADULTS URIC ACID

-

TYPES -

t.ca OXALATE
} MONOHYDRATE
DIHYDRATE me
FORMED NORMAL URINE
→ IN
pH
→ LEAD TO HEMAT UREA

2. TRIPLE PHOSPHATE
→ FORMED IN ALKALINE URINE
→ LEADS TO FORMATION OF STAG HORN CALCULI

3 CYSTINE STONE
→ HARDEST STONE

4. URIC ACID STONE

→ RADIOLUCENT C NOT SEEN ON X-RAY)
☆ PAIN RELATED TO STONE =

→ KIDNEY -

FIXED LUMBAR PAIN

→ UPPER 43ʳᵈ URETER LP RADIATE
- TO
TESTIS
→ MIDDLE 43rd URETER LP RADIATE TO ILIAC FOSSA
-

→ INTRAMURAL URETER STONE -

PAINFUL DESIRE TO PASS URINE

→ BLADDER STONE -
SUPRA PUBIC PAIN
BLADDER NECK PAIN
→
GURETHERA SUPRA PUBIC REFFERED
-

TO TIP OF PENIS
1st Ix →
X-RAY -

KUB
Ixoc → NC -
CT

CLAPP → 1St RELIEF PAIN → DICLOFENAC

IF STONE 25mm -
PLENTY OF FLUID
IF STONE 75mm -
TOC -
ESWL
IF STONE 71.5cm -
Toc -
PCNL

FOR BLADDER STONE -

LITHOPAXYT CYSTOSCOPE

☆ ACUTE APPENDICITIS

MC POSITION - RETROCAECAL
MCC -
FEACOLITH OBSTRUCTION
INFECTION

SCORING USED -
MANTRELS SCORE ¥7
 CIP →

PAIN PATH DEMONSTRATED BY PT

POINTING SIGN -

MCBURNEY 'S SIGN PAIN IN Rt ILIAC FOSSA

-

ROUSING 9s SIGN PAIN IN Lt ILIAC FOSSA

-

'

PSOAS 'S SIGN -

PAIN FELT ON HYPEREXTENSION OF

⑧ HIP
IOC -

CECT ABDOMEN
Rx -

SEVERE OPERATIVE
_

EMERGENCY -

APPENDICECTOMY
↳ MC Incision GRID IRON
-

MCBURNEY 'S INCISION

-

MILD -

IF PT . IS ASYMPTOMATIC C- APPENDICULAR MASS

↓
OCHSNER SHERREN REGIME
→ IVF + IN Ab 5- 7-
days
&
→ INTERVAL APPENDICECTOMY AFTER 3-6 WEEKS

☆ INFLAMMATORY BOWEL DISEASE

-EEKfxffEBnBd -000bEur 0800500

☆ BLADDER TRAUMA

INTRAPERITONEAL RUPTURE EXTRA PERITONEAL RUPTURE

→ BEER DRINKING
→ TRAUMA
-10 OVER DISTENDED → MCC RTA → PELVIC #
BLADDER
N /
O E- TEARDROP BLADDER
Ixoc -

CYSTOGRAM
REPAIR BLADDER C- C-
Rx -

Rx -

REPAIR BLADDER
LAPAROTOMY LAPAROTOMY

☆ URETHRA TRAUMA

POSTERIOR URETHRA / ANTERIOR URETHRA /

MEMBRANOUS URETHRA BULBAR URETHRA

MCC -

RTA -
PELVIC # MCC -

MAN HOLE INJURY

MC URETHRAL RUPTURE
D. RE -

HIGH LYING PROSTATE

⑦ E- BLOOD AT EXTERNAL
OF BLOOD AT EXT .
URETHRAL URETHRAL MEATUS
MEATUS
Ix -
RETROGRADE URETHROGRAM
Ix -
RETROGRADE UREFNROGRAM
RX SVPRAPUBK CYST OSTOMY
RX SUPRA PUBIC CYSTOSTOMY
-
☆ BPH -
BENIGN PROSTATE HYPERPLASIA

ETIOLOGY -
TESTOSTERONE ¥01,5 DIHYDROTESTERONE
MC SITE -

TRANSITIONAL ZONE ,
MEDIAN LOBE

CIF -
LUTS LOWR URINARY
-
TRACT SYMPTOMS
→ A FREQUENCY
→ URGE INCONTINENCE
→ POOR FLOW
→ RETENTION OF FLOW

Cal DRE ENLARGED PROSTATE

App →
-
.

Ixoc - US -

Abdomen
s.BA >
Ynglmg
-

Rx -
MILD SYMPTOM
DOC FIN ASTRIDE
- > TAMSULOSIN

SEVERE CONDITION
1- URP -
TRANS URETHRAL RESECTION OF

PROSTATE
↳ IRRIGATION FLUID OF CHOICE GLYCRLNE 1.5%
-
☆ HERNIA

→ MC IN YOUNG MALES → INDIRECT INGUINAL

→ me IN ELDERLY MALES → DIRECT INGUINAL

→ mc HERNIA IN FEMALE → FEMORAL

→ MC HERNIA UNDERGO STRANGULATION → FEMORAL

ynrouanfpxepznauinn-L-ransversn.us
INDIRECT DIRECT

AGE YOUNG ELDERLY

protrude
RING FASCIA
CHESSEL BACK 'S A)
RELATION C- INFR .
LATERAL MEDIAL
EPIGASTRIC VESSEL

* BEST LANDMARK TODD INDIRECT FROM DIRECT

INGUINAL HERNIA INFERIOR EPIGASTRIC VESSEL
-

☆ NYHUS CLASSIFICATION
I -

INDIRECT
II -
INDIRECT
☒ -
A DIRECT
B BOTH DIRE -14 INDI RET
C FEMORAL
II -
RECURRENT
☆ CONTENT CLASSIFICATION

OMENTOCELE -
OMENTUM
ENTEROCELE -

INTESTINE
LITT REX -
MECKEL 'S DIVERTICULUM
AmtAND'S -

APPENDIX
RICHTER 'S -
CIRCUMFRENCE OF INTESTINE
MAYDL'S -
W LOOP OF INTESTINE
SLIDING - MC SIGMOID
-

COLON
PANTALOON -
BOTH DIRET -1 INDIRECT
COOPER 'S -
FEMORAL -1 INGUINAL

MC -
CF -

INGUINO SCROTAL SWELLING

CL . EXAM -
SUPINE - RESOLVE
STANDING -
PROTUDE
3 FINGER TEST -
ZIEMAN 'S TEST

Rx -
AIM -
REDUCE CONTENT ,
APPLY BARRIER

→ OPEN Sx .
-

HERNIOPLASTY -
LITCHENSTEIN TENSION
FREE MESH REPAIR
→ MESH USED -
POLYPROPYLENE

-10C FOR CONGENITAL HERNIA HERNIOTOMX -

70C FOR HYDROCELE HERM Otomo AGE OF OPR > 3 YRS

-
- .
* FEMORAL HERNIA ☆ UMBLICAL HERNIA
Rx -
MCEVEDY Rx MYO 'S OPERATION
-

LOCKWOOD
LOTHIESSEN

☆ TORSION OF TESTIS

MCC - •
BELL CLAPPER DEFORMITY
•
HIGH INVESTMENT OF TUNICA
VAGINALIS

C. P - •
SUDDEN SEVERE PAIN
•
SWELLING REDNESS IN SCROTUM
,

TEST - PHERN TEST ④ IN EPIDIDXMO ORCHITIS

② IN TORSION

Rx -

212-24 hrs IF TESTIS IS VIABLE

-

ORCMIDOPEXY ,
CONTRA & IPSILATERAL
-
712-24 hrs IF TESTA IS DEAD
-
ORCHIDECTOMY CONTRALATERAL ORCMIDOPEXY
,
☆ VARICOCELE -

→ DUE TO ABNORMAL DILATION OF PAMPINIFORM

PLEXUS OF VEIN AROUND TESTIS

MC -
SITE -
②
0 / E- BAG OF WARM FEELING
Rx -
SCLERO THERAPY
VARICOCOELECTOMY
↳ ALTERNATE ROUTE -
CREMASTERIC VEIN

☆ HYDROCELE

→ ABNORMAL COLLECTION OF FLUID C- IN PROCESS US

VAGINALIS

MCC -

FILARIASIS
c) F- MC -
SCROTAL SWELLING
TRANS ILLUMINATION TEST ⊕

Ixoc -

US -
SCROTUM

Rx -
EVERSION OF SAC
↳ 3ABOULA.MS OPERATION

RX CONG . HERNIA -
HERNIOTOMY 73 YRS
 PHIMOSIS PARAPHIMOSIS

→ INABLITY TO RETRACT → INABLITY TO BRING

PREPUCE ONTO GLANS BACK RETRACTED PREPUCE

→ PHYSIOLOGICAL -

Upto 3 YRS RX -

REDUCE SWELLING +

MANUAL REDUCTION OF
Rx > HRS -

CIRCUMCISION PREPUCE

☆ PEYRONIE 'S DISEASE

→ HARD FIBROUS PLAQUE IN ONE OR

BOTH CORPORA CAVERN A

Rx -

REASSURE INITIALLY
&
→ IF PERSIST 718 MONTH → ESWL .
OR
→ NESBIT 'S OPERATION → CREATE ANOTHER PLAQUE
IN OPP . CAVERN OSA

*
FRACTURE PENIS
RUPTURE OF TUNICA OF CORPORA CAVERN OSA
→

MCC OVERENTHUSIASTIC SEXUAL INTERCOURSE

-

RX -

REPAIR TUNICA
☆ PRIAPISM -

→ PERSIST ANT PATHOLOGICAL ERECTION > 4Wd

MCC -
ANTIPSYCHOTIC DRUGS
OVER USE OF SILDENAFIL

Rx - • BLOODASPIRATION
•
SHUNT OPERATION
☆ RECTAL PROLAPSE

Rx -

CHILDREN -
DIGITAL REPOSITIONING -6 WEEKS
ADULTS PERINEAL OPERATION THIERSCH WIRING
_
-

DELORME 's
ALTEME.RU
☆ HAEMORRHOID 'S [ PILES]
→ PROLAPSE OF ANAL CUSHION

INTERNAL -

Above DENTATE LINE , PAINLESS , 3,7971 Klock

EXTERNAL -
BELOW DENTATE LINE PAINFUL
,

GRADING OF INTERNAL HEMORRHOID ES .

I -

MASS DO NOTPROTUDE OUT

II -

MASS PROTUDE OUT ON STRAINING &

GOES BACK SPONTANEOUSLY
IT -
MASS PROTUDE OUT ON STRAINING &
DOES NOT GOES BACK
☒ -
MASS PERMANENTLY OUTSIDE

/
MCC F- BLEEDING PER RECTUM [SPLASH)

Ixoc -
PROCTOSCOPY
Rx -
1° -
SCLCROTHERAPY
20 BANDING
_

3044° HEMORRHOIDECTOMY
-
☆ ANO RECTAL ABSCESS

MC SITE
-
-
PERIANAL
Mcc - INFECTION OF ANAL
CANAL
RX -
INCISION & DRAINAGE
↳ DIAMOND SHAPE INCISION

☆ FISTULA IN AND
ABNORMAL COMMUNICATION B/W SKIN
-57 AWAL
→

CANAL/ RECTUM
MCC -

INFECTION OF ANAL CANAL

RULE FOR Ant of Post FISTULA -
GOOD SALL'S RULE
ZXOC - MR FISTULOGRAM
Rx -

FUSTULOTOMY

☆ PILONIDAL SINUS / JEEP DRIVER DISEASE

RIF HAIRY GLUTEAL SKIN

PROLONG SITTING .

C) F SEROUS DISCHARGE FROM SKIN

RX -
PLASTIC Sx RECONSTRUCTION
 ONCO SURGERY

☆ ESOPHAGEAL CANCER

MC -

sq .
CELL CARCINOMA
R / F- SMOKING ALCOHOL
,
GERD
PLUMMER VINSON
PIRON DEF ANEMIA
GLOSSITIS
.

SYNDROME
§ ESOPHAGI AL WEBS
C) F- DYSPHAGIA [ INITIALLY FOR SOLIDS ]
REGURGITATION
HOARSENESS OF VOICE -
INV . OF RLN
ANOREXIA WT LOSS
,

Ix -
BARNUM SWALLOW → RAT TAIL Appearance
IOC - V92 -
ENDOSCOPY 1- BIOPSY
STAGING IOC -
CECT
METASTASIS IOC -
PET SCAN -
18 FDG

STAGING
TI -
SUBMUCOSA NI -
I -21N MI -

METASTASIS
T2 -
MUSCLE N2 -3-6 LN

73
-

ADVENTITIA N} -

> 7- LN

Ty ADJACENT ORGAN
•
-

PROXIMAL 10cm
Surgery ↳→ DISTAL
-

Rx -
-5cm
IVOR LEWIS OPERATION - TOTAL ESOPHAGECTOMY
C- ESO . RECONSTRUCTION
 ☆ STOMACH CANCER

MC -
ADENOCARCINOMA
RF -
SMOKING ALCOHOL
,
↑ SALT A PICKLE
, ,
↓ VITAMIN

MENETRIER 'S DISEASE

On Ex -
LINITIS PLASTIC A [ LEATHER BOTTLE App]
C / F- MALENA ,
HEMET EMESIS
EPIGASTRIC MASS
wt LOSS
TROUSSEAU 'S SIGN -

MIGRATORY THROMBOPHLEBITIS
GENETIC P53 , SMARCA
-
- I
SPREAD -

1. LOCAL PROXIMAL Ca SPLEEN

→↳ .
→

DISTAL Ca .
→ PANCREAS
VIRCHOW 'S NODE ENLARGED②
µ IRISH Sups CLAVKULARLN
-

2. LYMPHATICS → -
NODE -

ENLARGED AXILLARY LN
3. BLOOD LIVER -

4. DIRECT PERITONEAL SPREAD

↳ PERIUMBLICAL -
SISTER MARY JOSEPH NODULES
↳ OVARIAN -

KRUKENBURG Tumor
↳ RECTAL WALL -

BUMMER A SHELF
 C

IXOC -
V92 ENDOSCOPY + BIOPSY
STAGING -
CECT
METASTASIS -
PET SCAN

RX -
PROXIMAL GASTRIC CANCER -

TOTAL GASTRECTOMY
+ SPLENECTOMY
SX MARGIN
-
= 5cm

DISTAL GASTRIC CANCER -

PARTIAL GASTRECTOMY

☆ COLORECTAL CANCERS

MC-ADE.NO CARCINOMA
MC SITE -
RECTO SIGMOID

R/F- ↑ ANIMAL FAT

↓ FIBER
SMOKING
FAMILIAL ADENOMATOUS POLYP
↳ GARDNER SYNDROME FAP -1 EPIDERMOID CYSTS
-

↳ TURCO-19s SYNDROME FAP -1 BRAIN TUMOR

-

CIF -

② COLON Ca -
BLEEDING
② COLON Ca - OBSTRUCTION

Ixoc -

COLONOSCOPY -1 BIOPSY
SX -

MARGIN -
5cm FOR COLON CANCER
2cm FOR RECTAL CANCER

⑧ -

HEMI COLECTOMY
② -
HEMI COLECTOMY

☆ ANAL CANAL CANCER

TYPE
Squamous CELL CARCINOMA

Txoc -

NIGRO REGIME
↳ CTH -
SFU OXALIPLATIN
g
↳ TARGET THERAPY -
CETUXIMAB

☆ CARCINOMA OF GALL BLADDER

MC -
SITE -

FUNDUS OF G. B
TYPE -
ADENOCARCINOMA
RIF -

GALLSTONE § POLYPS g
TYPHOID CARRIER

CIF
-

JAUNDICE
Ixoc
-

CECT
Rx -
RADICAL CHOLECYSTECTOMY
[ REMOVAL OF G. B. 1- ↳ N]
☆ CARCINOMA OF PANCREAS

MC TYPE -

ADENOMA
MC SITE -
HEAD OF PANCREAS > PERIAMPUCLARY
RIF -

SMOKING
CHRONIC PANCREATITIS
Dm
/
C F- JAUNDICE
MARKED WT LOSS

IXOC -
ca HEAD OF PANCREAS → CECT
PERI AMPULLARY Ca → ERCP-1 BIOPSY
'

TUMOR MARKER -
CA 19-9

Rx -
WHIPPLE 'S OPERATION

☆ KIDNEY TUMOR 9s

I → WILM 'S TUMOR -

NEPHROBLASTOMA
25 YEARS
ETIO -
INACTIVATION OF WT SUPPRESSOR GENES
MC -
SITE -
UPPER POLE OF KIDNEY
c) F- LUMBAR -
MASS IXOC -
CECT Abdomen
PYREXIA -R✗ -

5×-1 CTH
HEMATUREA ↳ NEPHRECTOMY
-1T ADULT KIDNEY CANCER -
HYPERNEPHROMA

Mc TYPE -
ADENOCARCINOMA [CLEAR CELL TYPE ]
MC SITE -

PCT EPITHELIUM

RIF -
SMOKING
DYES -
ANILINE DYES

CIF -
LUMBAR MASS
PAINLESS HEMATURIA
② VARICOCELE
1St IX -
URINE CYTOLOGY FOR MALIGNANT CELL
20C -
CECT Abdomen
Rx -
SX -
< 7cm - PARTIAL NEPHRECTOMY
> 7cm -

RADICAL NEPHRECTOMY

☆ BLADDER TUMOR

MC -

TRANSITIONAL CELL CARA NOMA > Sqcc

MC SITE -
LATERAL BLADDER WALL
RIF -

SMOKING DYES CHEMICAL

, ,

CIF -
PAINLESS HEMATURIA
1St Ix -

URINE CYTOLOGY
30C -
CYSTOSCOPY + BIOPSY
IXOC FOR STAGING -
MRI

RX -
NONINVASIVE → TURBT .

INVASIVE → RADICAL CYSTECTOMY

☆ PROSTATE CANCER

→ me -
CANCER IN ELDERLY MALE
SITE -
PERIPHERAL ZONE
,
POSTERIAL LOBE
RIF -
ANDROGEN ↑
SPREAD -
LUMBAR VERTEBRA THROUGH BATESON 'S VERTEBRAL
PLEXUS OF VEIN
-
BONY METASTASIS → OSTEBLASTIC

Ixoc -

PROSTATIC BIOPSY
STAGING -
MRI
METASTASIS - PETS CAN
TUMOR MARKER -
SERUM PSA 710

RX -
ca c- IN PROSTATE -

RADICAL PROSTATECTOMY
ADVANCED Ca -
HORMONAL THERAPY
↓
RADICAL PROSTATECTOMY
+

BIL ORCHIDECTOMY
* PENILE CANCER
Mc CELL CARCINOMA
Sq
-

MC SITE -
GLANS / PREPUCE
RIP -
POOR HYGEINE
HPV
LONGSTANDING GENITAL WARTS

/
C F- FOUL SMELLING GROWTH ON THE PENIS
ENLARGE INGUINAL L N .

↳ MCC OF DEATH → EROSION OF VESSEL

3×0 C- BIOPSY
RX ONLY GLANS INVOLVED → PARTIAL PENECTOMY
-

FULL PENIS INVOLVED → TOTAL PENECTOMX

RX -
FOR ↳ N ENLARGEMENT -
ANTIBIOTIC 3. WEEKS
&
IF PERSIST -
REMOVAL

☆ TESTICULAR TUMOR
me GERM CELL TUMOR
- .

↳ me SEMI NOM Almost RADIO SENSTNETOMOPD

-

Mcc -
UNDESTENDED TESTIS
CIF -

MC SCROTAL ENLARGEMENT
-

EPIGASTRIC LUMP
CANON BALL
App IN LUNGS
-

TUMOR MARKER -
✗ FETO PROTEIN

Ixoc -

CECT ABDOMEN

Rx -
CTH _
BLEOMYCIN ,
ETOPOSIDE g
CISPLATIN

☆ THYROID CANCER -

I PAPILLARY THYROID CANCER

II FOLLICULAR THYROID CANCER
III MEDULLARY THYROID CANCER

I PAPILLARY FOLLICULAR
•

II

Mcc -
RADIATION LONG STANDING ENDEMIC
GOITER

PATHO -
ORPHAN ANNIE EYE NUCLEI CAPSULAR INVASION
PSAMMOMA BODIES

CIF SWELLING SWELLING

7. MARKER SERUM THYROGLOBVHN

RX TOTAL TYROIDECTOMY C-
↳ N REMOVAL
HI MEDULLARY THYROID CANCER

ARISE FROM PARA FOLLICULAR C- CELL

TUMOR MARKER -
SERUM CALCITONIN

ASSOCIATED WITH MEN -

I

C) F- NECK SWELLING ENLARGED 2N

g

Rx -
TOTAL THYROIDECTOMY C- REMOVAL OF LN .