FBsLuN) Co) gia) Aina Aa) jal! 5slal Gastrointestinal Tract and Hepatobilliary System Assay eval Jasna gis)€ € 0 Qt) torihe abot Sheek Notes abent premalignant Conditions oF the ESophagus 2 ® Achalosia @ Barretesephagus @ Corresive stacdure ® Plimmer Vinson Syndrome, © Wiel ® Smo Kins a3) Girchy yearsold man presented as Upper gachrs she Bell o dee to esophageal Varices wit povielbeypectensiont. # whet are Complication ¥ portal Wapectension? @ Gastroesephogtal Verices @ Accrtes __C Sportan cous bacterial peri ea @ Splenemegaly 5 Hypecsplenisen : G Kepatic Failure ® Hemecrherds @O pectel a gestersthy ” a thhote are indication x sooo ee ee as _ Systemic Shunt 2 wc/T Tipssi- B) Recacrent Marie blending, @ Failed endoscory therapy ( Foilure | #1 Fagk aboot ee © Uncontratted acne variceal Mecking —_¢ d : ORig ht sided heart oh | © @ Pahient intolerant to endoscopic, therapy © c® pebgegstic Liver disease GE Mig Z > © Severs eeate re hepa { |® P Strraecy, cxshmindicatih by peackepatic Fanction argeeccale a Con ion Opaient awaiting Liver trccplartakion QY) diseuse brieFly extrahepatic shat 2 Eine Fextrhepatic shunt is to decrease uiheleer pat oF perbal Verne Circulation s these shunts require aSurgical procedure and oce indicates es sith Tailed endexcaple testes i “Thies main extrahepatic shuvte ave A @ Total shucks (Cprctecoval):- whale sE wee al: Venous. eluate is Fully decompressed 5 No Pectal. Vein Fla in to the Liver sine: idence high to ence phalopoths @ Partial Shuntt( Narrow diameter partocaval)i-= whole oF: ds Portal Vencns cicentatin ic partly decompressed , Some. Pockal. Flow conbinues.» So Port openskive encepaale pally As. reduced. @ Selective shunts (distal Splenorinal)i-is iseleted parteF the portal civenlation is Fully decompressed fa ae) QB) usteare tie Canses oF Upper Cncen ctl ma and investigation and Managuect @ } ae tr heey CHyenic Gore Quaauue Baldy: pepllc Ulcec, Maltpleerosion 26% @ Aorfo-entecic Gs esophageal Varices or GastnicVarices4¥. (Q) SeverreFlex exc Mallory -Weiss Syndrome 1% ® Bleeling tendency y Tamenrs Cesophagenh,' Gastec) © Nose Bleed or Nai ophary =ngsat Bleeding,eo ® @ ¥ Investigation + GQicpe c H.Bs pevs wB.c count 5 platle ChiHting study Cpr prt, L NR) @ Renal Finchin seelectralytes ® Endescopy Cesophagee -gastro- degdencscop Bariam studies @ Radionnelidescanning @ Rn giegeapley: + — Histecy SZ Sxaminebign inves Vaahions- QResuscitations Bic rLargje bore Connla, Chart manitorin 3 Bisod transfusion, Central Venens Catheters Nasogastvic tube insertion. ete Le @ Medical trentinendt > Bedvect — Blsal fanshiten anhactle ~aralgesia TRenevamicacd — wk cecnenes) O)Eidoscepy Oe yection Sclere Nempy Q37) @ Ligation (Bandins) @ injection adrenlive ® Laser Phote > coagulection © Electro. koag olationC d ‘act herreo) D efeetive Tedeitnees pinto Skee Bleeding, las als a2® 99. ClWvonic Gastric and duodenal leer * ~Filereplacty PTRuwdhiNagehany ~ P8ctod Gastrectomy Falleved By Jastegejunestens CBitLroHh 1, Biltedh 2) * Bleeding eseplagend Varies? “Tipse. Blea t, > Energy ere Pectocaval shunt MSsver Beedieywwifh No TdentPble Cause. ae pleng qastr dusdenotomy, ] a0) Seoyphiation oF pe phe Ulcer 2 in O Bleeding - Crane Bleeding CAnenis)_, acuche Bleeding, Ganlead toshack @ | pecForation *- acute pain , Bleeding may present @ perctration \- deep Uleee trong | Cpancreas , Lives) » 2 @ Ste i= MarrowoF Lumen Becouse Scar, edema inflammation > If ok pyloric &tenosi s) Lead to Von’stins, of huge Nelume oF qastei< ef _| Content. wwohole into Near araan | —_ Brslignant transformation := AssticUloee Premalignant - — —Duhel ave the managment oF Pyleric stenosis . soe Li Varwitg oF Large Volume oF gastriccontent 4 eravnectiont- dehydrated 2 Misible peristalsis »Pslpehlemace .efe # Trveshystions. Wee, electrolyte , U/Sabdemen endescopy Om + —erbt By Seay OTRaudryeyank aatentng | >” @ TRuncal Nlageteny and gastryejtrestomy© © Qs) Whot ar the managment ake pecForated peptictliees: 2 * Hicclor = Sadler Severe epigashic pain » Vaciable defreeak sheck | H Examinactiin:- abdominal tenderness, ragidiby ell »_ Tnvestipelim pladuat Ray oe Free Nic Haden * Treatwent 2 Simple Closure rel | ~ parietal cell Vagatang and omental patch. ‘a -TRaneal Vag etoeg and py Loroplasty e TRuncal Vag atom and antvectomy 3) whatare indication Far esephaga scopy, fo *Disgneshe ae OTe-evaluate. Syaplerce cE dysphssia watene P hagia i regucgitetion:. «Hematemicis @ To asses esephageL pathology. se phagitis tumours , couskichiul = @ Te Cen Fires rodialeqical abnormality 1. stricture, tumene MVarices, €se phagrhs adivecticula. 4 @ assessment of post ogerctive problem Skcickwre tumour necentect Bleeding, sreccuvent GERD. 6 Ei ndescapt U/}frasound (Combine en sescopy u/s) immage, 8 | Z | inFormotion abact esophagus end Serre ting Nissne = ral’ __# Tiecapecien - —- — ORemeval Fortin Body ©. dietedion oF chricture. tn © Loser phstecoagletion For Meedinl oc Sumo @ B Placemest oF erkluninal pasthess(stet —_ |@ | &\) ageoscepy 2 ! hae: 9re Hoe compli cxlion aFresophage: OMiner Complications ae ee ~Lacemtion oF Wp, bungie pdislo Lament oF tee: ; ~ Pharygcal Laceration - @ Mejor Complication: | ~PecKoration \-2% oF — Cate a Forign Bedy) — +e other i— "bee Prenmenia ———= ~ Stwehue (Loney \erm), +e - Sever eStphagitis : 12] woltm sob net teem QW) whet ave the clinical Feature oF Gogh oene Cancer 2 Tas RK Symptom ond Sign -d4spepsiq - mest avarsion ~ discom Fact oN - Anerexia _, wt Less , frenia. = epiqastn'c mass » Hematemisis, melaca = Virche's Nodes di piers in. ae ee a __-Kra Kenloungy's tumour :-oVarian mastitis - Blamec’s shelf tin rectum: ara) what are the slassiFication oF Basivic Canter eC Lassih Beaton _ x Loren (Finnish) clas classifechon. ree Tatestinal Sastric cancer La ned i 2 iF Fase. gastric Chntee = Sa | ae@ — ; ‘aoe Seg V8 Tepanece claulicnbiag ce Sith. wshiis Set Ta TasType te ptatiaded’. I< ste 2siksalcth AAS i Te Tipe 2 SupeFicial 7 R2 ns clove 428 s- Flat #20 to depres: % Bormann slossificotionca F Advanced gastriccancer Typed Poly potd TH Pe2 Carcinomatons Ulcer without invasion sradyeceat ma TY Pe Carcnematous Uleeo with invasion © adjecent Y @ Tyre di FFasely in Fill rative Umitis plastica * TNM staging oF Gastriccanceat: ae Ti Invasion oF nncesa® Sebirmcatsin 2 9 N~Repenal LN!) Te Powsenlaris Invasion. ~ Nes-NelL-N- ao Te Seresa invasion. = Nitin metastesicte LN. TH sdjectet scteseture easion ae | oN dictact metas = Mo: No distant mehachasic = Mat cuidencec® distant metastasis @ HK TRectment Farce Qulg ee Ace Remathecey, ssa Mech dey ap _ Surgical resection only Cure 0) Temarek RY Lens uence _ Sublatelgastrectemy +L.N clearance 4 Gasitre qe junester BeeQNetien cicat Bolt. _ FG _Totalgastrectemy 4 LN. clearance + Roux -EN- 4 | — @Terer Fer Landes 9 cardia: Cescphages Jefinestors) OSePhagec- Zaetrectomath-Ni Clearance + Roux. Se 4 |ay) hat 2 ~ 9re the Couse of Right Was Yossa pain ? [ What are Dif Fre, fel diagnesis oF Appendicitis ® . Ox pPendicitic OV Aete re gdnnsetencle @o varian cyst / torsion @ Meckel's divertio\\ is @ Reptued ectopic _ Uretyic stone CUrelic pan) Pregnancy © pepte Ulcer Pelvic IWF Lameestory @acute chelycystitis disease 7 @ Pancrectitec QL) whet ere. fest apperdicectomy Complication’< im Owound nhection = 1 Tnieanddeakal cbscecs @ Fecol Wstala @ Tleug a @ adhesive interkinal chstraction @) Nenens Viromboembcion QRight Tngqumal herrea 5 ' GORespicatecy complication : © portal Pyemia, rr. | ~— —— meee — 15) whet are the oppendiular Mass managment 2 aan J | io in ee ee deo! SMe j ees, H/o Appendicitis = Examination t Right iliac Fossa mass _ Fever | _ Taternal: opening Relow the Arovectal ring, I ~ High Fistula i-Tnteenal spesieg atvove the Anscecteb ies, ( Rng Yemical classi Keaton t= © i \ciiaenae a @ Subwn cous Fai Anal. High Anal ®pelvirecteL — K Packs classi Hcection \. uty ES - Inter-sphinctric : ———— =TWRans-seirctinie iH i - Supra. Spkndiric CSepre Levetor) * Good Salt’s Rates | E Rt ated Bstula t- witherternal Fishla Opening tendtobedived Type Cshvight track) ss I > las exteynat opening curved tracks CHerse chee) pall ee Mo Hiple. external opening a ohshet se _@22) write about type, classiestien managment oF agrctal ae Fistula 2. = Pee SA | classification S4y pe. Aiscussed aboved Ls = managment é srbn pus — | _ x Mistery Rexaninehon £ investiga ton _|—— _____tpereistanh dischagye Causes invitation Xdigconm For | = Fam is nist present ~exNemakopening is Usually one | 2) PRY Feel internal opening SomeHme> opening© @ ~Proctescopy > Estulogeaphy : : = MRT = Peking KT Reatment = X Fishlotomy CRistalatrack mwtBe oper) probing heal Ry + Trvestigactien Seat eehos * Fishabestemy Ceow ple excision oF Fis tla teack) oe SIE Sphincler wjcy Trcantenance xi iV Fiskulasckous Bhoge dpeattion ay what ore the clagsiFachion oF Hacmorvheids, classibicetion and Bramanynen Se % Classi Rea tion Oistdegree.. \- Bree L Bar dost palagse. @ Ind legree 1 prolapse reduce Gpontanconsly | Lateri¥s Need 4 replaced manually CRebal) GB Aridegre _s- Feemenen’ velapicel Piles EANErR|L Emo rho s * Lnternadl Nemerrheid ae dented bine pees Breeding, Parless , + BrightRed adnong ubaa na J — Feelapse __, Tischerye spreads Anemia | prlapse Bleeding dncharge . palerete ee oT Hrasbesed piles 2» SKintags _ tion Prcclascopy ,Siqwoidecco py PRS Cper rectal erainakin)Om wiecion Sclerotternpy, @-elatas he Rand @- ceo Seegecy OM rhot. Ceagelation@ GAS) shat are the classification oF Rectal prelepse smbranseyncaX®, # Classifications + Opactal C Mucosa + Sulmucesa) = Ocomplete prelapse Cpracidentis) we prabrusion of Milater || — manag ment i. | a Hishers 2- Commorin oldage Celdecly) — Pretresien Fremannhep ening | cw Paina incomplete evacnatin » Bleady dicichen recto di Fecal Jncenbinence ar censipation me Exacta * Ask patie.t ta beac dean A Lnvestzatins. Calonescopy ov Barium exenta C40 rol te Bekecag raphy Bre) # [Reatment:- a Yeasurauce: =TReach risks Fecha si) “Teething them digtel reper honiy, *~ = Surgical sutveng of Rene Sten) Nia abdeminad. ov Perineal. appraacs @28) Conses oF PainEul Kral Canal . Jaceeie CA oie RAs it ites = = eae O THrombesed external Meme erhoid See hoc _ = Ble pressureol Anal Venu Sudlien , Veryenin Full Tenses, tend, setel 9 4 TRealrmeat:. Went Supicsl evacuation Wade |) F a ee a@ ® Anal Fissure elongated Ulcer in Long AxisiieF the tswen: Analcanal. ACIE spain 4 spaser of Anal canal. skin tag Celvanic) ATReadrent i. conservative» Steel seFtenee s High Fibec dint = GTN CGlyceryl trinitrate) ~CHemicat $phincteretamy: } ~ Geataldilatation oF Rnal Sehenclér Under GA | ~ Lateral syhinclerotomy ~ Wnal Flap @Avalearbscess:- . > Perianat abscess » Sulrmacons Mbscess » Techeorectal: Pelvirectad abcess» Fissure abscess —- TReatoren ti By Suvgical drainage Under GA GSE MC steal teopsetted diverse) Rerper sing 1 taunta HPVs Fung: TReatments- Unterying Gause @ Brat cancers: ASL Bleebing -mass - eHaage ih Bowel habits , Pon mag presit __tranaqment i= vw Wistery 28 Examine itn River hgction #2 Sweqeney, saMenctherapiy, Radiotherapy. ad S| _ Psoriasis , wart ete __xCLE ss Bleeding TT ety span tment Under ing Cause. ia Fuga + (Variant Levator ani sy “a cafh » stein jn Rectum and Anus - -aa) Write abaxt the oa sSHistolegy d Pathological types and Staging 529) and Managment oF calorectal Carcinema ? = popillifeous @ malignant Ulcer @ orn S colloid tumeur ©; FEyse ints een # MP Arerescopy:- - = Aderocarcingma —__@... a TReedwert ie j Nete ut Side: Rae \y a brtinectisns ~ Wise _@ History. - Ghosnans vat Re SiAe Leckes olds denotes bi~ Anenaa » Anevexia svotLosr = Locak i-_CHangein Beael Habit = perFershen - Bleeding pecrectum ~ Tn Nestinod ole stewction ~ Metastasis t¢ —andite —» Hepatomeqally 2 Asci-hs ee 4 Exansinadren = sesel + O Pal pable mass tnabdenten ocpecrectam @ evidence oFintestnalobstiaction (Vorsiting Bde wee | Conslipalion »fsain) B Anemia, wtLoss a @ evidence Spread mr 2a eth eee HB as niches Sion witit | Stage Syrade. Coleg iss Sethe, | Operative SS SS = ess oF grooth 69 Me regional | al ieececaF Cees Ona Asstnling Clon ic Rink heeaicalecte wemeetanl nithial JN and Tien Colic anastmesis eee. Weasley. si olen j= LeFE i Removal oF | BRnastuesis . fumeuref Sigmeid clon Sigqmedecctectonay, ae 2 F Upper Wa. + Resechiong Lity Re # Palliafi Ve Ti iF metastatic- Ta gett Wadi wn Bile duct DM Bijiacn colic @Biliacy oRstractian Q@) Rate cWelaystrhis @ acute Molengitis: @ CRrenic CHelexystitis ® Acute pencreaths. Dem seo oF gall Biadder stl. Oi iets My des oe —_|@petostinn fates E | _ Stone in commanBile duck @ . ag) What are. Fhe. Geli achone camplicertion 12 Se lens 23) _DeFine fasts le ecssbechony Repke samen © 157%. oF patient , CHoLecystectomy Failte. scitaie the ea ive (GT Q. Problem related tothe pe ae | = Ke re Pannagmens si Store incyshc dectg | a) Mancament oF kone ln-Comnnes sled wha Ge © Mansgment started AN Sheng e Os — = A symp homectie CHe La, argchs (Pain + Fondice, Fever) DRiad HE xaminctions Tendenness Ane giqactric and Ri tak Wyrochaabeinm = Yellowish discolarection sF GEN Sclern HT avestigattoas: | LET ~eobstrachiyeqentice Coot Gad Ser) ~ ~ By _U/e »ilated CRE Qmayascocinted ti IKGIR stone ~ERep SmRep Bestaption At >) paSasgment: on —-= O =. StopPoctive monagwneat. 5 Relegd calionyilcaraetion Fala SO uiiality , Briad spectrumatbiatic eee Q@relieF of abstruction isessential @ Endoscopic papilletomy with Sphinctrectint, O Remeve oF shne By demiabasket ocplasenen tek Stent ty | ae 9 OF this s technique Fails percutaneous transhepetic ctilangrercaph te prvide drainage { @ Surgerf 6 Haledochetamy vate 4 Used CRin cic Atoin, = Spice eis ee | Q Donnie tll seated Dehn tebe) 9, MR i. ond EREP Thevapuctic manceuvres, oF Se “tases diagnaced PostePerative _ Ml)@ / kage oF Bile oc Rile per —percatanacusly Cotheter 4 ~ Stet - ERCP - e Surgery yepair - Baloor dilation 5 stent» ~ Surgery ortcame isyeed Late d Wydaction Ove Cre PAC JKEK trakepae :. @ cancerhead oF Pantrense| QCAD stone @ Miri Stypdreme: @ citdangrecorcinema Gta @ Fesampuilacy Werrenie @ Hydatideys+ @© fancvectitis #Inveh afta < I Ri a ALT Alpi chiang ot us fase G ableminc£ d/S @ Ma Rep -Caeyrelic resonance CHelangis i @eaep ! = Cendescepic retugrade men —— © CT Scan: - © Pereutenus trans hepatic cHola ngiographyyi~ @ Endoscopic Ultrasound - ala) what ave the aranag nent Hanagmedt stacted Rae 2 bisticd we etelehand) geHlistany 3 Spain ia Right Hy pachen i sad yithlichy y | Fy Right Shovider associated with Nausea. and Vernitinge _ @ @ Feve , Tachycardia els nation!- Morphyfs sian (Qve) Jeioe ea — oe Bicestip Hon: ae ot tS. finite ee Ee we ndabdement- gallstone» dilated eWBladdem . thie Kwall,@ ( __¥TRewtments. O- cUelecystectones treatment Felsice : > Time ig Sontraversel ~eerly intervention ~ other delay apprach @ Consenmhive treatment Followed by cWclecse beck ts = - ~ mere han Sete oF cases Symphoms Subse oth censemustve | treatment jucludes ee ONAL permouth @ LvFiwid OPralyesia ORR ¢ © Fallow Up: Tempratir , pulse. other phy sicade Sips saFte= | | ‘nFlanvaaHiin Su hcide-dvad. Fluid tort awdveq lacie ~ potion sentheme and return Later when in Famatin has completly | resolved Far~ cHeLecystectemy Capyretimatly Gveels) SS @LF Pain and tenderness merease depending on the status oF patient operative Intenwahin and CHelesystectsan, Should Re peAenmed @ Renting early opawtien:- anh ae Urgent apeca tion as aroutine measure (Sone Surmeant) ei ‘ -widh 5- tdey operstivn Fran the onset oF attack tifler By Laprascepic ¢Holecy, nes ¢ ERP APET tng Under UJs guided =|) © TLE Comerbid > Percutanons cHebecgstus a =) whate are the radidegial invech atin Big y “ _ poll stone [efo - calcification = Gras Cempheys ™ a Bee this _€ ) Ultrasound t 4 i a a Bie all stne se)“SMe ani Licknecs af gpllBiad der ~ AnH aimatiin evil Galt Blakder SSieoh Common bile duct | Sho Wg Care) noma ck partren se = Dilated intrnhepalic an de Ftrahepal's bike duct Cobs tection) @ Magnetic resonance chilengiopanitad estas: QaiRep) = rat om Baie = Expensive and dicgneshe only > Nom invasive = Diagnostic ard bherapuctic oa — details Rrcclomy it} ~ Stones - Bian, Slachure +(e ~ Invasign : ———— © _Recewtenond TRanshepatt ctelang’ graphy: (STE a [Prados a |- Stone =Riltass) siriclice. cee G) Kindascapic Ul bre Sens ~ bpecuvate Immaging of Common Laila duck. detect stone. A __| dioqnesis of Peviampallary Cancer 4 Pancreat Cancer — +e G, Rabe Toole scan Ulepahc mine dncehe il) > EDA Sen — p Fees Lina Leak Dabogere biliary shrichore: ws hans (ED Tipe oF ctlegeg phy © 06S hy oayn LS ~ @orat eZ Helecys togtaph QLIV citelang legvaphy | - @pic @ ERep O©pre spective cHolary ingraphy @opratre ctelaryragiply O Pestepratie T- tube | i ra@ cSs @ ey te hepatic acters 16 leieap ed Kigached Bit © Perks L ein injury shenlt Revepaived SCAnP ODAT Fase _pamndeymal injury Shelithe treated 8y packing the livers Against dip hee gy Céeampressien) and temevek akte-Wheur @ Artdbichc cover 2vecehttimeremml @ teat any Coagulopatlcy G@) subceputar hematoma veclve spactanoacly a8) vahat are He clinical presentation , diagnosis and: JReatment ot Hydatid disease 2 ¥ clinical presestation': Upper ableminal discewPart + Hepa tomega lly acute abkminal pain able mmectramma Bic wepture s& C4 sh inte peritoneal cavity cough and dycprea it eet : = Cam rnplare theorgh dinghraayn emapyem® and into biliary tract | Pre den cisnsy obslradive Tandice ~|_Nen Spesific uRever , Anerexia , wtLoss > Nausea , Vomit - Fever | = may Be Asywptemetis ao polit an | i (Sere Lilie allem ee ELisa D t = Mnichyodicleyy, Serelegy | = Ubkesoundt. Mulbleatated cyth _. eReans: Bloating est@) (433) hat are the managment oF Siqmaid Valvalas’? «History and ttamintion ands inves tigate and treatment‘ x stay obdominel pain calicky Clek t Lower auadrat) - Ricate distension ~ Constipection ~ Vere fing is b Late Sign # Examination. | Bdomimal. disteasion ABdamitad terdecness # Tavesthpetion: = abdominal X Bag i= aly, Shaped oF distended Sigmsict Leap -CaF Fee - Bean sgn A Bird's S peak | an ra ~ dilated Bowel - CTécan Fer Assesment of wall [ecnemia # TRect mesh ; are = Bectation andiecompression By rectal twoe , ciben esuepy Or Sijmeide scopy ts -laprescopy dertatien or Lapcttang pray Need Rodel reseliin — —Secopgey = Suto fFixection oF Rowel to Parichat pertedua QA) shad: are He. indicection Fas Splmcctonsy ond Gomphinke® deh dications Pecks 0 Tnheri ted Heme Goes Compete Scop ____ tafesis © THalascnemia , cicktecell dieace (Oe Hemeel yb Anemic _ = | OLrnune thrombo cy topes (laa all { | QD Parfal Hy pectension ie : O fet "a Spd ee m Rowmedic raphe oF S pleen Eis me ) Te trag ence Splenectomy, iPax eaecoatecltt QD Splente Vern Phranhesis- spleas artegy ance Set = ©) CY54 > fimcur splenic) Sets ¥ * Bost Splenectomy ¢ complicatinat Dovecunewm ng pest. cplenectomss inbectis Serigus Corn plicection Be preumococci meaingeceees avd Naeme e foF Mento -~S/E 1- Sepsis (Fever , nie) hla ~Prephglactic immunization Ceres ¢ = An tibiohe a Fhe Sintec nada dete (oe eee. al pai