SURGERY

RAPID REVISION
By
DR. SANDEEP

ARISE MEDICAL ACADEMY

https://instagram.com/arisemedicalacademy
www.arisemedicalacademy.com

RISE WITH ARISE

DR. SANDEEP SEERAMREDDI

sandeep seeramreddi

FOLLOW US ON

INSTAGRAM
GENERAL SURGERY

Drains
I.V CANNULA
COLOUR SIZE FLOW
LAPROSCOPY
ENERGY DEVICES

MONOPOLAR BIPOLAR HARMONIC THUNDERBEAT

SUTURING RULE
1. LENGTH OF THE

SUTURE MATERIAL

2. DEPTH OF THE

WOUND

3. ANGLE B/W NEEDLE

AND SKIN
4. DISTANCE BETWEEN

2 SUTURES

5. LENGTH OF SUTURE

EAR

SUTURING TECHNIQUE
KNOTTING TECHNIQUE

SUTURE REMOVAL PERIOD

FACE

SCALP

ARMS

TRUNK

LEGS

HAND/FEET

PALMS/SOLES
 PRESSURE SORE/BED SORE/ DECUBITUS ULCER

CRITERIA:

RISK FACTORS:

SITES:

GRADE DISCRIPTION MANAGEMENT

I

II

III

IV
 BURNS

BURN WOUND ASSESSMENT WALLACE RULE (RULE OF 9)

ADULT CHILDREN
CLASSIFICATION OF BURN WOUNDS BASED ON DEPTH

CRITERIA FIRST SECOND SECOND THIRD FOURTH

DEGREE DEGREE DEGREE DEGREE DEGREE
SUPERFICIAL DEEP
Structures
involved

Pain

Blisters

Color

Heels

Scar

Eschar
RESUSCITATION IN BURNS PATIENT

Crystalloids

PARKLAND
FORMULA

ATLS MOST COMMON FLUID USED:

Table 9-1 Burn Resuscitation fluid rates and target urine output
by burn type and age
Category Age and Weight Adjusted Fluid Urine Output
of Burn Rates
Flame or Adults and 2ml 0.5Ml/kg/hr
Scald older children LRxkgx%TBSA
(>14 Years old)
Children(<14 1Ml/kg/hr
years old) 3ml
LRxkgx%TBSA
Infants and 3ml 1mL/kg/hr
young children LRxkgx%TBSA
(30 kg) Plus a sugar-
containing
solution at
maintenance
rate
Electrical All ages 4ml 1-1.5 mL/kg/hr
Injury LRxkgx%TBSA urine clears
until urine
clears
LR, Lactated Ringer’s solution. TBSA, total body surface area

COLLOIDS
MUIR AND BARCLAY
BURN WOUND MANAGEMENT

Topical agents Pseudomonas Gram Eschar Side effect

negative
1. 1% silver
sulphadiazine
cream

2. 0.5% silver
nitrate
solution

3. Mafenide
acetate cream

4. Serum
nitrate, silver
sulphadiazine
and cerium
nitrate
 HYPER PARATHYROIDISM

PRIMARY SECONDARY TERTIARY

HYPERPARATHYROIDISM HYPERPARATHYROIDISM HYPERPARATHYROIDISM

Etiology Increase in secretion of Due to chronic Autonomous reactive

PTH hypocalcemia Hyperplasia

Cause 1. Parathyroid 1. Chronic renal failure 1. Post renal transplant

adenoma 2. Vit D3 deficiency
2. Parathyroid 3. Intestinal
hyperplasia malabsorption
3. Parathyroid 4. Lithium
carcinoma

CLINICAL FEATURES OF HYPERPARATHYROIDISM

KIDNEY PAINFUL ABDOMINAL PSYCHIC FATIGUE

STONES BONES GROANS MOANS OVERTONES
Composition of
stones:
INVESTIGATIONS:
1 HPTH 2 HPTH 3 HPTH
PTH

Serum calcium

Serum phosphate

X-RAY FINDINGS

Investigation of choice: SESTAMIBI SCAN

Best / gold standard: 4D CT MANAGEMENT

PARATHYROID ADENOMA PARATHYROID HYPERPLASIA

FNAC OF THYROID SWELLING: OPTIMUM CYTOLOGY CRITERIA

1. Size of needle:

2. Number of aspirates:

3. Number of follicles per aspirate:

4. Number of cells per follicle:

INFLAMMATORY THYROID SWELLINGS

CRITRERIA HASHIMOTO'S DEQUERVIANS REIDELS

Type of
inflammation

Etiology

Pathophysiology

Antibody

HLA

Age

Sex

Clinical features

Thyroid status
(initial)

Intermediate

Final

Investigation

Management
 PAPILLARY CANCER FOLLICULAR CANCER ANAPLASTIC MEDULLARY
CARCINOMA CARCINOMA
Origin

Incidence 80% 10% 5% 2.5%

Age

Sex

Gene BRAF/PTC1/PTC2 PTEN /BAX RET

Risk factors

Clinical
features

Mode of
spread
m/c site for
Metastasis

Investigations

HPE
 BREAST

BIRADS SCORING (Breast Imaging and Reporting Data System)

CAREGORY DISCRIPTION PROBABILITY OF MANAGEMENT
MALIGNANCY
0 Incomplete N/A Repeat or recall for
assessment additional Imaging
1 Negative 0% Routine screening
2 Benign 0% Routine screening
3 Probably benign ≤ 2% Follow up after 6
months
4 Suspicious of 10-95% Biopsy
malignancy

5 Highly suggestive of ≥ 95% Biopsy

malignancy
6 Biopsy proven 100% Stage wise
management

BREAST ABSCESS

MOST COMMON ORGANISM:

MOST COMMON SOURCE:

CLINICAL FEATURES

Conditions associated with delayed

fluctuation sign
Investigation of choice

Management: 1st line: 2nd line:

BREAST SURGERY

SIMPLE
MASTECTOMY

RADICAL
MASTECTOMY

MODIFIED
RADICAL
MASTECTOMY

STRUCTURES
PRESERVED IN A
MRM
B

COMPLICATIONS
ASSOCIATED WITH S
MRM
W

B
 VASCULAR SURGERY
BUERGERS (T.A.O) ATHEROSCLEROSIS
AGE
RISK FACTOR
M/C LIMBS
SIZE OF
VESSEL
PATTERN OF
INVOLVEMENT
PROGRESSION

STRUCTURES
INVOLVED

ABPI
NORMAL
CALCIFIED BLOOD VESSLES
INTERMITTENT CLAUDICATION
REST PAIN
CRITICAL LIMB ISCHEMIA

AORTO-ILIAC ILIAC FEMOROPOPLETIAL

OCCLUSION OCCLUSION OCCLUSION
Claudication
Gluteus
Thigh
Calf
Management
VARICOSE VEIN: CEAP CLASSIFICATION
C0
C1
C2
C2r
C3
C4A
C4B
C4C
C5
C6
C6r

Ep Pr
Es Po
En Pro
Pn

As
Ad
Ap
An
MANAGEMENT OF VARICOSE VEIN
TRENDELENBURG SURGERY

SCLEROTHERAPY
AGENT -

METHOD -

AIR:SA –

BISGARDS REGIMEN
E
E
E
 DVT
VIRCHOWS TRIAD

M/C SITE FOR DVT:

M/C SITE FOR DVT CAUSING P.E:

ANTICOAGULATION
0 1 2 3 4 5 6 7
LMWH
WARFARIN

Target INR:

DVT with contraindication for anticoagulation:

H.I.T syndrome:
PLASTIC SURGERY
CLEFT LIP AND PALATE REPAIR TIME
Defect Repair time

Unilatera Cleft lip

Bilateral Cleft lip

Cleft palate soft

Cleft palate hard

Cleft palate soft & hard

Cleft lip and palate (U/L)

Cleft lip and palate (B/L)

NUTRITION
INDICATIO OF TPN
1. SHORT BOWEL SYNDROME
2. HIGH OUTPUT ECF
3. ACUTE ACTIVE IBD
4. INITIAL PHASE OF ACUTE PANCREATITIS
5. PROLONGED ILEUS >72 HOURS

COMPOSITION OF TPN AND ENERYGY

COMPOSITION % ENERGY
CARBOHYDRATES

FAT

PROTIENS

VITAMINS

TRACE ELEMENTS

COMPLICATIONS A/W TPN

TUBE RELATED FEEDING RELATED
TRAUMA

TRIAGE CRITERIA: Triage involves the sorting of patients based on the resources required
for treatment and the resources that are actually available

BLACK

RED

YELLOW

GREEN

HEMORRHAGIC SHOCK
CRITERIA CLASS I CLASS II CLASS III CLASS IV
%BLOOD
LOSS
HR

BP

PP

RR

URINE
OUTPUT
GCS

BLOOD
TRANSFUSION
Head injury classification using the Glasgow Coma Scale (GCS) score

Minor head injury

Mild head injury
Moderate head injury
Severe head injury

NICE GUIDELINES
Indications for CT imaging
within 1 hour
GCS at any point
GCS at 2 hours
FND
Skull #
Vomiting
Seizure

EDH SDH

Diffuse axonal injury

CUSHINGS TRIAD

Lethal triad of trauma

Stages of DCS
I

II

III

IV

V
FAST (FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA)
4P EVALUATION

eFAST

Minimum fluid required for FSAT +ve:

Splenic trauma
m/c organ injury in abdominal trauma:

m/c organ injury in blunt trauma abdomen:

m/c organ injury in penetrating trauma abdomen:

m/c organ injury in car seat belt:

m/c abdominal organ injury in a blast injury:

Grades of splenic injury
GRADES HEMATOMA LACERATION Mx
I

II

III

IV

SPLENECTOMY VACCINATION
 ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA

PATHOGENENESIS OF T.O.F

TYPES OF T.O.F

CLINICAL FEATURES
INVESTIGATION

ASSOCIATED ANOMALIES

V
A
C
T
E
R
L

MANAGEMENT : APPROACH – RIGHT THOROCOTOMY

WHICH LIMB OF ATRESIA IS
MOBILISED?

WAIT PERIOD FOR LONG

DISTANCE ATRESIA

IDEAL CONDUIT

OTHER CONDUITS

POST OPERATIVE COMPLICATIONS • GER (25%–50%)

• Anastomotic stricture (15%–30%)
• Anastomotic leak (10%–20%)
• Tracheomalacia (8%–15%)

CONGENITAL DIAPHRAGMATIC HERNIA

Bochdalek hernia Morgagni hernia

CLINICAL FEATURES
M/C Organ to herniate: Stomach> spleen> Transverse colon

AGE:
INVESTIGATIONS

MANAGEMENT
Complications
GASTROESOPHAGEAL REFLUX DISEASE (GERD)

DEFENITION:

ETIOLOGY:

CAUSES FOR DECREASE IN LES TONE RISK FACTORS

PATHOPHYSIOLOGY AND CLINICAL FEATURES

COMPLICATIONS

1. Esophagitis
2. SHORTENING of length
3. Hiatal hernia

4. Esophageal stricture
5. BARRETTS ESOPHAGUS
INVESTIGATIONS FOR GERD

24 hours PH PPI MUST BE STOPPED BEFORE :

monitoring
MANAGEMENT OF GERD

MEDICAL MANAGEMENT 1. Lifestyle modification

2. PPI for 8wks
3. Small frequent feeds
4.
SURGICAL MANAGEMENT Indications for surgery
1. Not responding to medical management
2. Barrett’s esophagus
3. Stricture
4. Hiatus hernia
5. Malignancy

SURGERY
 MOTILITY DISORDERS OF ESOPHAGUS

Achalasia Cardia Diffuse Esophageal Spasm

Investigations

Management

Endoscopic management
 DYSPHAGIA

DYSPHAGIA

SOLIDS AND
SOLIDS ONLY
LIQUIDS

NON NON
PROGRESSIVE PROGRESSIVE
PROGRESSIVE PROGRESSIVE
 DIVERTICULAR DISORDERS OF ESOPHAGUS

Pushing Diverticulum Pulling Epiphrenic

Zenner’s diverticulum (Acquired) Diverticulum diverticulu
Mid Esophageal / Para m
bronchial
Diverticulum(acquired)

Investigation
Management
ESOPHAGEAL RADIOLOGICAL SPOTTER
 STOMACH

CHPS: CONGENITAL HYPERTROPIC PYLORIC STENOSIS

PATHOGENESIS

CLICNICAL FEATURES

ON EXAMINATION

1. Olive lump
2. Visible peristalsis
3. Scaphoid abdomen

Serum electrolyte imbalance

Investigations

Management :
NEONATES WITH RECURRENT VOMITING

AGE OF 4TH WEEK DAY 0/1 DAY 0/1

PRESENTATION

VOMITING

TYPE OF
VOMITING

IMAGING

MANAGEMENT
 PEPTIC ULCER DISEASE
Criteria Duodenal ulcer Gastric ulcer

Site

Ulcer environment

Pain

Appetite

Weight

Risk for hemorrhage

Risk for perforation

Premalignant

INVESTIGATION

H.Pylori • Urease assay PPI must be stopped 2 weeks prior

Antibiotics to be stopped 4 weeks prior
• Histology

• Culture

• Urea breath test

• Stool antigen

• Serology: IgG AB

MANAGEMENT TRIPPLE THERAPY: PPI + clarithromycin + QUADRAPLE THERAPY: PPI + clarithromycin

amoxicillin/METRONIDAZOLE + amoxicillin/METRONIDAZOLE +
BISMUTH
 GASTRIC CARCINOMA
RISK FACTORS

NUTRITIONAL • Low fat or protein consumption

• Salted meat or fish
• High nitrate consumption
• Obesity
• High complex carbohydrate consumption
ENVIRONMENTAL • Poor food preparation (smoked, salted)
• Lack of refrigeration
• Poor drinking water (e.g., contaminated well water) Smoking and alcohol
MEDICAL • Prior gastric surgery
• Helicobacter pylori and Epstein-Barr virus infection Hereditary predisposition
• Prior abdominal irradiation
• Atrophic gastritis
• Adenomatous polyps
OTHERS • Male sex
• Low socioeconomic class

CLINICAL FEATURES

ATYPICAL PRESENTATION

ENLARGED LEFT SUPRA

CLAVICULAR LYMPH
NODES
IRISH LYMPH NODES

SISTER MARY JOSEPH LN

KRUKENBERG TUMOUR

BLUMMER SHELF
Investigations

UGIE

EUS

CT

PET

STAGING LAPROSCOPY

MANAGEMENT OF GASTRIC CARCINOMA

Mallory Weiss tear

GAVE (gastric antral vascular ectasia)

Dieulafoy Lesion
 VARICEAL BLEEDING

PORTAL HYPERTENSION

NORMAL PORTAL PRESSURE

PRE PORTAL HYPERTENSION
PORTAL HYPERTENSION
BLEEDING FROM VARICES
INCREASE IN MORTALITY

CAUSES FOR PORTAL HYPERTENSION

PORTO-SYSTEMIC COLLATERALS
MANAGEMENT OF BLEEDING ESOPHAGEAL VARICES
 MECKEL’S DIVERTICUUM Remanent of vitello- Intestinal duct

RULE of 2

Complications

Bleeding Obstruction Diverticulitis

IOC:

Mx:

Most common neoplasm of meckel’s diverticulum:

New: Incidentally found asymptomatic Meckel’s Diverticulum are to be operated

Indications
1. Age<50 years
2. Male sex
3. Diverticulum length >2cm
4. Ectopic tissue +
5. Palpable abnormality
 INTUSSUSCEPTION VOLVULUS

MANAGEMENT MANAGEMENT
 INFLAMMATORY BOWEL DISEASE

CROHN’S DISEASE ULCERATIVE COLITIS

AGE

SEX

RISK FACTOR

PROTECTIVE

GENE

SITES
INVOLVED

CLINICAL
FEATURES
RADIOLOGICA
L
FEATURES

Gross
appearance

Extra
intestinal
manifestation

Management
HEREDITARY CANCER SYNDROME

FAMILIAL GARDNER TURCOT PEUTZ

ADENOMATOUS SYNDROME SYNDROME JEHGER
POLYPOSIS SYNDROME
PATERN OF
INHERITANCE

GENE

CHROMOSOME

FEATURES
 COLON CARCINOMA
Most common site

Most common type

RISK FACTORS
Pathophysiology

Clinical features

Right sided colon cancer Left sided colon cancer

Investigations

% of syncronous lesions:
DUKES STAGING

B1

B2

C1

C2

TMN CLASSIFICATION

T N M
T1: Into submucosa N0: No nodes involved M0: No metastases
T2: Into muscularis propria N1: 1-3 nodes involved M1: Metastases
T3: Into pericolic fat or subserosa but not breaching serosa N2: Four or more nodes
T4: Breaches serosa or directly involving another organ involved

MINIMUM NUMBER OF LYPHNODES TO BE REMOVED FOR STAGING: 12

MANAGEMENT
RESECTION
TUMOUR RESECTION EXTENT BLOOD VESSEL
LOCATION
CEACUM RIGHT HEMICOLECTOMY TERMINAL ILEUM TO MID ICA, RCA, RMCA
TRANSVERSE COLON

ASCENDING RIGHT HEMICOLECTOMY TERMINAL ILEUM TO MID ICA, RCA, RMCA

COLON TRANSVERSE COLON

HEPATIC FLEXTURE EXTENDED RIGHT TERMINAL ILEUM TO ICA, RCA, MCA

HEMICOLECTOMY DESCENDING COLON

TRANSVERSE EXTENDED RIGHT TERMINAL ILEUM TO ICA, RCA, MCA

COLON HEMICOLECTOMY DESCENDING COLON

SPLENIC FLEXTURE EXTENDED LEFT RIGHT FLEXTURE TO MCA, LCA, IMA

HEMICOLECTOMY RECTOSIGMOID JUNCTION

DESCENDING LEFT HEMI COLECTOMY LEFT FLEXTURE TO SIGMOID LMCA, IMA

COLON COLON

SIGMOID COLON RECTOSIGMOID DESCENDING COLON TO IMA

RESECTION RECTUM
 RECTAL PROLAPSE
PARTIAL/Mucosal COMPLETE/ Full-thickness
prolapse prolapse/PROCIDENTIA
CRITERIA

CAUSE

C/F

INVESTIGATION

MANAGEMENT
HEMORRHOIDS

PRIMARY SECONDARY

INTERNAL ESTERNAL

Grade Bleeding Protrusion

II

III

IV
 PERIANAL FISTULA

CAUSE
PRIMARY SECONDARY

PARKS CLASSIFICATION

Intersphincteric

Trans-sphincteric

Suprasphincteric

Extrasphincteric
 GOOD SALL’S RULE

C/F:

IOC:

MX:
 G.I LIST
LIST 1
DISORDER MOST COMMON SITE /MOST COMMON TYPE
• TOF
• ACHALASIA CARDIA
• ZENKERS DIVERTICULUM
• ESOPHAGEAL CARCINOMA
• BARRETS ESOPHAGUS
• WEB IN PLUMMER VINSON SYNDROME

• BOERHAAVE SYNDROME
• MALLORY WEISS TEAR
• PEPTIC ULCER DISEASE
• GASTRIC ULCER
• INTUSSUSCEPTION
• VOLVULUS
• DIVERTICULOSIS
• POLYPS
• TB STRICTURE
• TYPHOID PERFORATION
• UC
• CD
• HIRSCHPRUNGS DISEASE
• ISCHEMIC COLITIS
• SMA ARTERY SYNDROME
• ACUTE MESENTRIC ISCHEMIA

• L.I MALIGNANCY
• PERFORATION IN PUD
• HEMORRHAGE IN PUD
• M/C SOURCE OF BLEEDING IN PUD

• FISTULA IN ANO
• HEMORRHOIDS
• ANAL CANCER
 LIST 2
NAMED ULCER SITE
APTHOUS ULCER

CAMAROONS ULCER

PUD

GASTRIC ULCER

DUODENAL ULCER

TB ULCER

TYPHOID ULCER

BELT SHAPED ULCER

FLASK SHAPED ULCER

SERPENTINE ULCER

COBBEL STONE MUCOSA

SOLITARY RECTAL ULCER

SKIP ULCERS
 LIST 3
G.I MALIGNANCY CHEMO

ESOPHAGEAL CARCINOMA

STOMACH CARCINOMA

S.I ADENOCARCINOMA

L.I ADENO CARCINOMA

RECTAL CANCER

ANAL CARCINOMA

G.I.S.T

HCC

GB CARCINOMA

CHOLANGIO CARCINOMA

PANCREATIC DUCTAL ADENO

CARCINOMA
 LIST 4
G.I MALIGNANCY PROXIMAL MARGIN DISTAL MARGIN OF
OF RESECTION RESECTION
ESOPHAGEAL
CARCINOMA
STOMACH CANCER
S.I CARCINOMA
L.I CARCINOMA
RECTAL CARCINOMA
 LIST 5
DISORDER MANAGEMENT
ACHALASIA CARDIA
DES
ZENKERS DIVERTICULUM
ESOPHAGEAL CANCER
CHPS
PERFORATION PERITONITIS (PUD)
PUD
GERD
D1 STRICTURE
DUODENAL ATRESIA
JEJUNAL ATRESIA
ULCERATIVE COLITIS
DIVERTICULOSIS
FAP
RECTAL PROLAPSE
HSD
HEMORRHOIDS
ADENOC ARCINOMA OF ANAL
CANAL
 LIVER
LIVER RESECTION TERMINOLOGY

RIGHT HEMILIVER/ RIGHT

HEPATECTOMY

LEFT HEMILIVER/ LEFT HEPATECTOMY

RIGHT ANTERIOR SECTION

RIGHT POSTERIOR

LEFT LATERAL

LEFT MEDIAL

RIGHT TRISECTIONECTOMY

LEFT TRISECTIONECTOMY
 LIVER INFECTIONS

Pyogenic liver Amebic liver Hydatid cyst

abscess abscess

Causative agent

Route of spread

Age

sex

Most common
site in liver

Solitary Vs multiple

Endemic status

CLINICAL
FEATURES

1st INV USG USG USG: GHARBI’S CLASSN

IOC CECT CECT CECT

Confirm Aspiration&culture ELISA ELISA

Mx:
 BENIGN LIVER LESIONS

HEMANGIOMA FOCAL NODULAR Hepatic

HYPERPLASIA Adenoma
Pathogenesis

R|F

Pre-malignant

C|F

Complications

IOC

Mx
COMPARISON BETWEEN PRIMARY HCC AND FIBROLAMELLAR
HCC

HCC FIBROLAMELLAR – HCC

SEX RATIO

AGE

TUMOUR
NATURE

RESECTIBILITY

ASSOCIATION
WITH
CIRRHOSIS

AFP STATUS

ASSOCIATION
WITH HEP-B

PROGNOSIS
 BILIARY SYSTEM

CONGENITAL CHOLEDOCHAL CYST

Type I II III IVa IVb V

Intra hepatic

Extrahepatic

Clinical features

TRIAD

Complications

1. Cholangitis
2. Pancreatitis
3. Biliary peritonitis

INVESTIGATIONS
USG

MRCP

MANAGEMENT

TYPE I

TYPE II

TYPE III

TYPE Iva

TYPE IVb

TYPE V
 CHOLELITHIASIS

CHOLESTEROL STONES PIGMENTED STONES MIXED (M/C)

Complications associated with Gall Stones
 GALLSTONE ILEUS

Investigations

MX:
Exploratory laparotomy
 PANCREAS

PANCREATIC DIVISUM

Pathogenesis

Clinical features

Investigations

Management
 ANNULAR PANCREAS

Pathogenesis

Clinical features

Investigations

Managements
 CHRONIC PANCREATITIS
Risk factors

Clinical features

Exocrine insufficiency Endocrine insufficiency Ductal insufficiency

Investigations

IOC

BEST/GOLD STANDARD

Management : chronic pancreatitis

 CYSTIC LESION OF PANCREAS

Pseudocyst of Serous cyst Mucinous cyst Intraductal Papillary

pancreas Adenoma Adenoma Neoplasm

AGE

GENDER

APPEARANCE

COMMUNICATION
WITH DUCT

MOST COMMON
SITE
MUCIN STAIN

CEA

AMYLASE
INVESTIGATION

MANAGEMENT
 IMPORTANT TRIADS OF GIT
1: CARNEY TRIAD-
GIST + PARAGANGLIOMA + PULMONARY CHONDROMA

2: MECKLER’S TRIAD: TRIAD OF BOERHAAVE’S SYNDROME

RETCHING OR VOMITING + RETROSTERNAL PAIN + SURGICAL
EMPHYSEMA (AIR IN SUBCUTANEOUS PLANE)

3: BORCHARDT’S TRAID: TRIAD OF GASTRIC VOLVULUS

PAIN + RETCHING WITHOUT VOMITING + INABILITY TO PASS NGT

4: MURPHEY’S TRIAD: TRIAD OF APPENDICITIS

PAIN + VOMITING + FEVER

5: CHARCOT’S TRIAD: CHOLANGITIS (ALL INTERMITTENT)

PAIN + FEVER + JAUNDICE

6: QUINKE’S TRAID/ SANDBLAUM TRAID- TRIAD OF HAEMOBILIA

PAIN+ JAUNDICE + MALENA (OR GUAIAC TEST POSITIVE)

7: TILLAUX TRIAD: MESENTERIC CYST TRIAD

MID ABDOMINAL CYSTIC SWELLING + ONLY MOBILE
PERPENDICULAR TO ROOT OF MESENTERY (TILLAUX SIGN) +A BAND
OF BOWEL RESONANCE IN FRONT OF CYST
GIT X-ray
•
Tc scan of Meckel’s
URETRIC CONSTRICTIONS
 CONGENITAL DISORDERS

HORSESHOE KIDNEY Anomaly of Duplication Polycystic Kidney discase

clinical features
Management

HSK ECTOPIC URETERS PKD

NEPHROLITHIASIS

CALCIUM PHOSPHATE URIC ACID CYSTINE

OXALATE

CAUSE

CHACRECTERISTIC
FEATURES

RADIO STATUS
URINE
MICROSCOPY
CRYSTALS

CLINICAL FEATURES OF NEPHROLITHIASIS

 INVESTIGATION

USG

XRAY KUB

CT UROGRAPHY

DMSA

DTPA

MAG3

MANAGEMENT

<5MM 6-15MM >15MM STAGHORN

CALICULI
 GENITO URINARY TB

KIDNEY

BLADDER
PROSTATE

VAS

SCROTUM

RENAL CARCINOMA
 Clear Cell Papillary Chromophobe Bellini

C/F:

PARA NEOPLASTIC SYNDROME

 ROBSONS STAGING

STAGING

T0 NO EVIDENCE OF TUMOUR
T1a <4CM , LIMITED TO KIDNEY
T1b 4-7CM , LIMITED TO KIDNEY
T2 >7CM LIMITED TO KIDNEY
T3a TUMOUR INVADING ADRENAL GLAND OR PERINEPHRIC TISSUE BUT NOT BEYOND
GEROTA’S FASCIA
T3b TUMOUR INVOLVING RENAL VEIN OR VENACAVA BELOW DIAPHRAGM
T3c TUMOUR INVOLVING VENACAVA ABOVE DIAPHRAGM
T4 TUMOUR INVADES BEYOND GEROTA’S FASCIA
MANAGEMENT
 INTRA PERITONEAL EXTRA PERITONEAL
BLADDER RUPTURE BLADDER RUPTURE
CAUSE

CLINICAL
FEATURES

INVESTIGATION
S
 MANAGEMENT

Bladder Carcinoma

Transitional cell Squamous cell Adenocarcinoma

carcinoma carcinoma

C/F:

INVESTIGATION
CYSTOSCOPY

TUMOUR MARKER

MANAGEMENT OF BLADDER CANCER

MALE URETHRA
 URETHERAL INJURY

ANTERIOR URETHRAL INJURY POSTERIOR URETHRAL INJURY

IOC:

MANAGEMENT
 HYPOSPADIAS

C/F:

IOC:
MX:
 PENILE CARCINOMA
RISK FACTORS

C/F:

M/C/S:

IOC:
ERYTHROPLASIA OF QUEYRAT BOWEN'S DISEASE

MX
 BENIGN PROSTATIC HYPERPLASIA (BPH)

PATHOPHYSIOLOGY

C/F:

Voiding Storage
● hesitancy (worsened if the bladder is very full) ● frequency
● poor flow (unimproved by straining) ● nocturia
● intermittent stream – stops and starts ● urgency
● dribbling (including after micturition) ● urge incontinence
● sensation of poor bladder emptying ● nocturnal incontinence
● episodes of near retention (enuresis).
COMPLICATIONS

INV:

IOC:

P.S.A:
MX:

T.U.R.P

C/I: T.U.R.P:

OPEN SX:

NEW: HOLEP:
 CARCINOMA PROSTATE
M/C Type:

M/C/S:

R/F:

1. ELDERLY AGE
2. OBESITY
3. BRCA 2 > 1
4. ALCOHOL
5. SMOKING
6. INCREASED TESTOSTERONE
7. GENETIC : GSTP-1 (m/c) ON CHROMOSOME 11

CLINICAL FEATURES
INV:

IOC:

BEST:

IOC for Staging:

GLEASONS SCORING

Management
SCROTAL WALL
 CONGENITAL DISORDER OF TESTIS

UNDESCENDED TESTIS ECTOPIC TESTIS

Most common
site

Status of testis

Secondary
sexual
characteristics

Spermatogenesis

Scrotum

Investigations
Management of undescended testis
 TESTICULAR TORSION

R/F:

C/F:
PREHAN’S SIGN

O/E:

Investigation

Management
 VARICOCELE

CAUSE

Clinical features

IOC:

MX:
 HYDROCELE

CAUSE

TYPE
C/F:

O/E:

IOC:

MX:
 TESTICULAR TUMOURS

GERM CELL TUMOUR NON GERM CELL TUMOUR

C/F:

M/C ROUTE Of spread:

TM:

IOC:

IOC Staging:

Staging

Stage I: tumour confined to testis and epididymis

Stage II: nodal disease but confined to nodes below diaphragm

Stage III: nodal disease above the diaphragm

Stage IV: non lymphatic metastasis

 INDETERMINATE TESTICULAR MASS

MANAGEMENT OF TESTICULAR TUMOURS

FOURNIER’S GANGRENE
URO-RADIOLOGY
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