Diverticulosis

Hinchey Classification
Nipple eczema Vs Paget’s Disease
Testicular Torsion
Some sort of LBO ?
It's colorectal cancer if u look close I'll see the
apple core lesion
Cholelithiasis
Endovascular stent-graft repair of an
abdominal aortic aneurysm
JJ Stent
Lymphedema
Splenic Abscess ?
Splenic rupture ?
Inflammatory Breast Cancer
Late stage
Colorectal Cancer & a fecolith
Dense opacity with an irregular outline from
which spicules pass into the surrounding tissue
Late presentation of breast cancer where,the
breast is destroyed with ulceration and
evidence if cutaneous metastatic breast
carcinoma with lymphoedema of the chest &
upper limb
Venous Ulcer → located on medial malleolus ,
irregular edges with neoepithelium. Pink &
granulating base. Swelling present
Mass on left kidney ?
L kidney cancer ?
L kidney abscess
Gangrene of 1st and 2nd toes… dry gangrene
evident line of demarcation
Crohn's disease … skip lesions seen
A . History and physical examination
. jaundice and icterus refer to the yellow appearance to the skin, sclera, and mucous
membranes as a result of retention and systemic deposition of bilirubin.
aundice typically does not develop until the serum bilirubin level exceeds 2 . 5
o 3 . jaundice or icterus i s a reflection of liver disease, including obstruction of
he biliary tract, acute hepatic injury from drugs and toxins , and the chronic
oss of hepatic reserve from cirrhosis due to alcohol, the hepatitis virus(es) ,
ron or copper, and parasitic infection.
2 . The triad of splenomegaly, ascites , and caput medusae (dilated abdominal wall
veins) indicates portal hypertension. O ther signs/symptoms of cirrhosis and/or
portal hypertension can include a history of upper GI bleeding from esophageal
varices or hepatic encephalopathy from excessive NH3 levels , testicular
atrophy, spider angiomata, pain, and fatigue .
3 . A history of pruritus suggests cholestasis , either intrahepatic or extrahepatic.
Causes may be at the hepatocellular level (viral hepatitis) , canalicular level
drugs , total parenteral nutrition, amyloidosis) , or biliary ductal level (primary
biliary cirrhosis [ PBC ] , primary sclerosing cholangitis [ P SC ] ) .
B . Diagnostic laboratory testing
. Serum bilirubin levels , both conj ugated (direct) and unconjugated (indirect) ,
are affected in a number of disease processes and are related to the metabolism
of the bilirubin.
a. Unconjugated bilirubin is generally elevated in hemolysis , drug hepatotoxicity,
nherited enzymatic disorders (Gilbert disease, Crigler-Najj ar) , and
he physiologic disorders of the newborn.
b . Conj ugated bilirubin is usually elevated in hepatocellular diseases, cholestasis
or biliary obstruction.
2 . The serum transaminases alanine aminotransferase (ALT) and aspartate aminotransferase
AST) are nonspecific indicators of acute hepatocellular inj ury.
However, an AST:ALT ratio greater than 2 : 1 is more suggestive of alcoholic
iver disease .
3 . Alkaline phosphatase c a n be u s e d a s a marker of cholestasis . Alkaline phosphatase
s released by damaged hepatocytes as a consequence of cholestasis ,
but other organ and tissue production of alkaline phosphatase (e.g. , bone, placenta,
kidneys , and leukocytes) make it a nonspecific indicator in the evaluation
of liver disease. The heat-stable fraction of alkaline phosphatase is more
uggestive of liver pathology.
4. The synthetic function of the liver is measured by the serum albumin level and the
prothrombin time (PT) , the latter of which is reflective of the vitamin K-dependent
lotting factors II, VII, IX, and X. The most sensitive indicator of deficiency of hepatic
ynthetic function is an abnormal (prolonged) PT. No improvement in the PT
despite vitamin K administration reflects severe hepatic functional loss.