Penile carcinoma 153

D Penile malignancy, most commonly squamous cell carcinoma of the penile skin. A Chronic irritation is main risk factor. Human papilloma virus also implicated. A R Condyloma acuminata (e.g. warts, human papilloma virus), chronic infection of the foreskin (balanitis), smoking. Balanitis xerotica obliterans (a form of lichen sclerosus, a chronic inflammatory condition of the glans or foreskin), erythroplasia of Queyrat (a form of carcinoma in situ of the glans skin), Bowen's disease...

Retinal detachment 175

D Separation of the inner layers of the retina from the underlying retinal pigment epithelium (RPE) and choroid. A Proliferative diabetic retinopathy, sickle-cell disease, advanced retinopathy of prematurity and penetrating trauma give rise to tractional and or rhegmato-genous retinal detachment. Tumour growth and inflammation give rise to exudative or serous detachments. A R Associated with myopia, aphakia, pseudophakia, i.e. cataract removal with lens implant, trauma (including previous...

Squamous cell carcinoma 183

D Slow-growing malignancy of the squamous cells in the epidermis. A The main aetiological risk factor is UV radiation from sunlight exposure. Can also develop in areas of skin damage in burns, radiation or from chronic skin disease (e.g. lupus, leukoplakia). A R Exposure to carcinogens (like tar derivatives, cigarette smoke, soot, industrial oils and arsenic), radiation exposure, patients on long-term immunosuppres-sion (e.g. transplant recipients, HIV patients). _E Second most common cutaneous...

Flexible sigmoidoscopy and colonoscopy Diverticulae can be seen and

Other pathology (e.g. polyps or tumour) can be excluded. Bloods FBC (anaemia), WCC and inflammatory markers in acute disease. M GI bleed PR bleeding is often managed conservatively with nil by mouth, IV rehydration, antibiotics, blood transfusion if necessary. Diverticulitis Nil by mouth, IV antibiotics (cephalosporin and metronidazole) and IV fluid rehydration. Chronic High-fibre diet with bulking agent (e.g. methylcellulose). Laxatives may be required if constipation is severe. Encourage high...

Liver cirrhosis with portal hypertension Conversion from laparoscopic

(1) Inability to identify anatomy (3) Intraoperative metabolic acidosis The gallbladder lies on the undersurface of the liver, bound to it by the peritoneum. It is divided into a fundus, body, infundibulum and neck that may develop a Hartmann's pouch. The cystic duct connects the gallbladder to the junction of the common hepatic duct and bile duct and the musosa forms folds, known as the spiral valve of Heister. Anatomic variants are common, e.g. the cystic duct draining into the right hepatic...

Laparoscopic abdominal surgery 125

Minimal access surgery of the abdomen or pelvis, whereby following creation of a pneumoperitoneum, a rigid endoscope is introduced into the peritoneal cavity, through a sleeve, for inspection and to guide manipulation by other instruments introduced through other ports. Diagnostic Used in the investigation of abdominal or pelvic pain, focal liver disease, abdominal masses, staging of malignant disease, for directed biopsy or emergency evaluation of abdominal trauma. Therapeutic Abdominal...

Xrays of humerus AP and lateral views elbow and shoulder

Allows confirmation of location of fractures and any predisposing lesions (see Fig. 11). Bloods Unnecessary for uncomplicated fractures. Conservative Suitable for isolated uncomplicated fractures (e.g. closed or undisplaced). Functional bracing with collar and cuff for humeral neck fractures, or plaster-of-Paris cast for shaft fractures. Surgical Indicated for compound, open, displaced or pathological fractures or associated neurovascular injury. Open reduction and internal fixation for...

Testicular malignancies

T A Unknown, likely gene mutations in germ cells. 0 a R Testicular maldescent or ectopic testis risk 40x. Others are contralateral testicular tumour and atrophic testis. Uncommon, 1 of male malignancies, but most common malignancy in 18-35 years. Lifetime risk 1 500. Swelling or discomfort of the testes. Backache due to para-aortic lymph node enlargement. Respiratory symptom, shortness of breath or haemoptysis from lung metastases. Painless hard testicular mass...

Intestinal obstruction

T B D Obstruction of the normal movement of bowel contents. Classified according to site small or large bowel, partial or complete, simple or strangulated. Extramural Hernia, adhesions, bands, volvulous. Intramural Tumours, inflammatory strictures, e.g. in Crohn's disease or diver-ticulitis, intussusception. Intraluminal Pedunculated tumours, foreign body, e.g. bezoars, gallstones infection, e.g. worms. Common. More common in elderly due to increasing incidence of adhesions, hernias and...

Epididymitis and orchitis

D Inflammation of the epididymis or testes (orchitis). 60 of epididymitis are associated with orchitis and most cases of orchitis with epididymitis. A Majority of cases are infective in origin. Bacterial < 35 years most commonly Chlamydia or Gonococcus. > 35 years most common are coliforms. Rare TB, syphilis. Viral Mumps can cause orchitis. Fungal Candida if immunocompromised. 1 3 are idiopathic. May be associated with underlying testicular tumour. A R Diabetes. Rarely associated with...

Ulcerative colitis 197

D Chronic relapsing and remitting inflammatory disease of the large bowel. Together with Crohn's disease, this is known as inflammatory bowel disease. A Unknown. Suggested hypotheses include genetic susceptibility, immune response to bacterial or self-antigens, environmental factors, altered neutrophil function, abnormality in epithelial cell integrity. A R Positive family history of IBD 15 ). Associated with serum pANCA, PSC, other autoimmune diseases. _E Prevalence 1 1500 (in developed...

Breast abscess

D Abscess formation in breast tissues. Two main forms are recognised puerperal (lactational) and nonpuerperal. A Infection. Lactational most commonly with Staphylococcus aureus, nonpuerperal S. aureus and anaerobes, often enterococci or bacteroides spp. (TB and actinomycosis are extremely rare causes). A R Main risk factor lactation, with bacteria gaining access through cracked nipples. Nonpuerperal smoking, mammary duct ectasia periductal mastitis, an associated inflammatory breast cancer...

Anal fissure

D A longitudinal tear in the squamous epithelium of the distal anal canal. A Commonly caused by passage of a large hard stool, resulting in pain and sphincter spasm that interferes with local blood supply and hence, healing. A self-perpetuating cycle of pain, spasm and re-injury results. E Common, occurs at any age, especially 30-50 years and in children, males slightly more commonly than females. H Severe acute pain at the anus on defecation that may last from a few minutes to hours, often...

TlD There is a wide variety of hernias of the abdomen other than inguinal and femoral

Incisional hernia Herniation through a surgical incision scar. Umbilical and paraumbilical hernia Herniation through or around the umbilicus. Umbilical hernias occur in children, paraumbilical hernias in adults, where they usually have a narrow neck and are prone to strangulation. Epigastric hernia Herniation in the midline between the umbilicus and xiphi-sternum, through the linea alba. Associated with divarication of the rectum. Richter's hernia Hernias where only part of the bowel...

Peptic ulcer

r l D Ulceration of areas of the GI tract caused by exposure to gastric acid and pepsin. Most commonly gastric and duodenal (can also occur in oesophagus and Meckel's diverticulum). OA Cause is an imbalance between damaging action of acid and pepsin and mucosal protective mechanisms. Common Very strong association with Helicobacter pylori (present in 95 of duodenal and 70-80 of gastric ulcers), NSAID use. Rare Zollinger-Ellison syndrome. H R Weak association with smoking, alcohol, genetic...

Branchial cyst sinus and fistula

T l D Neck swelling or discharge that arises at the site of an embryonic pharyngeal pouch. Probably arise from congenital remnants of the 2nd pharyngeal pouch or branchial cleft, although the precise embryological origin is disputed. a R Occasionally associated with 1st or more rarely 3rd 4th cleft cysts. Branchial cysts are the most common, presenting most often in the third decade, with considerable variation, and in men slightly more often than over time, it is usually painless unless...

Gallstone disease as

D Stone formation in the gallbladder. A Mixed stones Contain cholesterol, calcium bilirubinate, phosphate and protein (80 ) due to imbalance between bile salts, phospholipids and cholesterol (supersaturation), nucleation factors and gallbladder motility. Pure cholesterol stones (10 ). Pigment stones (10 ) Black stones made of calcium bilirubinate ( bilirubin secondary to haemolytic disorders, cirrhosis), brown stones due to bile duct infestation by liver fluke Clonorchis sinensis. A R Mixed and...

Paralytic ileus

I D Functional bowel obstruction due to atony and disruption of normal peristalsis. ZA Post-op ileus following intra-abdominal surgery. Metabolic Hypokalaemia, hypomagnesaemia, ketoacidosis, uraemia, porphy- Inflammation Response to a local inflammatory process, e.g. appendicitis. Diffuse peritonitis Bacterial or chemical. Retroperitoneal pathology Haematoma, pancreatitis. Drugs Opioids, antipyschotics, anticholinergics, Parkinson's disease medica J Neuropathic disorders Diabetes, multiple...

Lipomas

T l D Lipomas are slow-growing benign tumours of adipose tissue. Lipomatosis refers to multiple contiguous lipomas that cause distortion of SC tissues (e.g. on buttock or rarely, neck). Lipomas can be classified by location, e.g. SC, subfascial, subsynovial. Unknown, certain chromosomal aberrations have been implicated (e.g. translocation of a gene on chromosome 12). A rare presentation is multiple tender lipomas (Dercum's disease ad pos s dolorosa). All ages, mostly 40-60 years, rare in...

Ischaemic lower limb Chronic

T B D Chronic arterial insufficiency to the lower limbs resulting in consequences ranging from pain on exercise (intermittent claudication) to ulceration or gangrene. r A Atherosclerosis in the lower aorta, iliac, femoral or other leg arteries. Q Q Smoking, hypertension, diabetes, hypercholesterolaemia, family history. Common, prevalence 7-15 of elderly population, male female is 2 1. Annual incidence of critical limb ischaemia is 50-100 100000 in the UK. IH La Fontaine classification system...

Femoral hernia

D The abnormal protrustion of a peritoneal sac, often with abdominal contents, through the femoral canal. A The predisposing factor is the anatomy of the femoral canal with distinct unyielding boundaries of medially the lacunar ligament, anteriorly the inguinal ligament, posteriorly the pectineal ligament and pubic bone, and laterally the femoral vein. The canal only usually consists of loose connective tissue and lymph node (Cloquet's node). A R Females (have a wider angle between the inguinal...

YTBI Emergency usually in the form of a Hartmanns procedure Obstruction perforation ischaemic bowel toxic megacolon

The sigmoid colon is characterised by an S-shaped loop of variable length joining the descending colon to the rectum at the level of the 3rd sacral segment. It has a mesentery whose root has an inverted V-shaped attachment along the external iliac vessels to the iliac bifurcation and to the anterior sacrum. The left ureter and bifurcation of the common iliac artery lie at the apex of the root. Vascular Arterial supply derives from the left colic and sigmoid arteries, and branches of the...

Ischaemic lower limb Acute 119

D Limb ischaemia due to sudden occlusion of the supplying artery. A Thrombosis For example, in atherosclerotic vessels. Embolism 90 from heart, 9 from great vessels, 1 other. Vascular injury For example, trauma or dissection. A R T Atherosclerosis, aneurysm, graft stenosis, thrombotic states. E Atrial fibrillation, recent MI, valvular heart disease, aneurysms, atrial myxoma may also occur during interventional radiological procedures. _E Uncommon but incidence may be increasing. H 6 Ps pallor,...

Mastectomy 135

Indications for mastectomy in breast cancer include A large gt 4cm or central subareolar breast tumour. Multifocal tumours or widespread carcinoma in situ. U Tumours fixed to underlying muscle or skin or those fungating through skin causing ulceration and bleeding 'toilet' mastectomy . The mammary gland consists of 15-20 lobes radiating outwards from the nipple. Each lobe is separated from the other by fibrous septa and from the underlying muscle by the retromammary space. The base of the...

Perineal abscesses and fistulae

T l Dj Perineal abscess A pus collection in the perineal region. Perineal fistula An abnormal chronically infected tract communicating be- tween the perineal skin and either the anal canal or rectum. Bacteria, often tracking from anal glands cause infection that the body's defenses do not overcome, with fistulae developing as a complication of abscess. The latter are also a complication of Crohn's disease, where multiple perineal fistulae may develop pepperpot perineum . May be associated with...