By James Gossage, Bijan Modarai, Arun Sahai, Richard Worth
The purpose of the a hundred situations sequence is to supply a unique studying and revision instrument that works through guiding the reader via medical situations, imitating those who scholars and junior medical professionals are inclined to meet in twist of fate and emergency and outpatient departments, and normally perform.
100 circumstances in Surgery offers a hundred surgical situations often visible and handled by means of clinical scholars and junior medical professionals. The patient's historical past, exam and preliminary research effects are provided along questions about the analysis and administration of every case. the reply contains a targeted dialogue on every one subject delivering a vital revision reduction for college students and junior doctors.
Making medical judgements is among the such a lot demanding and hard elements of educating to develop into a physician. those instances will educate scholars and junior medical professionals to recognize very important surgical stipulations and support them advance their diagnostic and administration skills.
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Extra info for 100 cases in surgery
What are the typical findings on examination? What are the differential diagnoses? What treatment would you recommend? 27 100 Cases in Surgery ANSWER 14 The most likely diagnosis is an anal fissure – this refers to a longitudinal tear in the anoderm within the distal one-third of the anal canal. Examination typically reveals a linear tear in the midline and posteriorly. Anterior fissures are more common in female patients. Chronic fissures are associated with skin tags, and the exposed fibres of the internal sphincter may be visible at their base.
43 100 Cases in Surgery ANSWER 21 Murphy’s sign has been demonstrated, which is described as tenderness under the tip of the ninth costal cartilage, which catches on inspiration. A palpable mass, caused by inflammation and adherent omentum, is present in up to 40 per cent of patients with cholecystitis. An abdominal ultrasound should be requested, which should confirm a thickened gallbladder wall with surrounding free fluid, supporting the diagnosis. The majority of episodes of acute cholecystitis settle with analgesia and antibiotics.
29 100 Cases in Surgery ANSWER 15 The x-ray demonstrates large-bowel obstruction. Large-bowel obstruction classically presents with lower abdominal pain, abdominal distension and absolute constipation. Vomiting is a late feature. The common causes of large-bowel obstruction are listed below: • Carcinoma: approximately 15 per cent of colorectal cancers present with obstruction and roughly 25 per cent are found to have distant metastases at the time of presentation • Diverticulitis: repeated episodes of diverticulitis can lead to fibrosis and narrowing of the colonic lumen • Volvulus: sigmoid volvulus typically occurs in older individuals with a history of constipation and straining, whereas caecal volvulus is seen in younger patients and is associated with a congenital defect in the peritoneum, resulting in inadequate fixation of the caecum • Intussusception: intussusception is most commonly seen in children; approximately 70 per cent of adult intussusceptions are caused by tumours • Colonic pseudo-obstruction: pseudo-obstruction or Ogilvie syndrome is seen most often in the elderly patient with chronic or severe illness In approximately 20 per cent of patients, the ileocaecal valve is competent resulting in a ‘closed-loop’ obstruction which does not allow decompression into the small bowel.
100 cases in surgery by James Gossage, Bijan Modarai, Arun Sahai, Richard Worth