D5

Aoupy etA 3uu

 Dr. JTM

TUREA

intellect
e s

pevsorality
emotions
conaciounes, oilh | uoiifout neus1ological Sighs
ov|sons
cal
olcgiccl siqns (vve)
reu
a¢ ahett (ueet msty odor to
boealh)
Cnanminahon

F A y y y oenoor

FAY o peoqoonn imple menlal aaitmahic tasks

okyecti Hke stoyY
oCHEXia-
MuO

-L exensor planhor 9eAponse

INESS e T I O N S

mde clinicallu
ioqneis Unuaily
stheuns dittAse sloOej e he noomal olpha uaves
oith eventual development o della uaves
3Alena mmonia ic utally inoeaed

MANANSMENT

Aimed to toeat oo 9emove poecipitoting causes and to

sppmesIAe poduchon o neuoiotoxins by bacresa in
ouel

Aochulose
1s to so m) 8 tmes daily
pocduces osmohic loxative ettect
Reduces he ph o6 the colonic Content
Aimting colonic ommmonia abscoIphon
Poovotés the incorporotion o nitogen into bacteria
RiLaximin 400 ma 3 times daily
Well tolerated, non- absobed anibiohic
Reduces the bachremal contert o he bouwel

JTM STuDy MaTERIAL

 Dr. JtM

estoiichion
9estoichion

pooteirn
3. Dietay iousE linetxeatme
teatmnen+
oust line
needed

Rarely as
as
molnouihe
used aloieady
in
No longer nutitiomal
Stale
wOrsen
pahients.
4 Liver THansplantarhion

îrdications
encephalopatf
LChonie| erokoHy

JTM STUDy MATERIAL

 Dr. JTM
SURGERY

1sCHIORECTAL ABScESS
Supralevator
abscess
Intersphincteric
Extrasphincteric
fistula
abscess
Suprasphincteric
fistula
Ischiorectal
abscess
Subanodermal/
subcutaneous Transsphincteric
fistula
abscess
Intersphincteric
fistula
Subanodermal/
Subcutaneous hstula
CAUSES

Oue to extension o
lower
Can be blood 0
umphohic inteumUBEUdaM
hom amal abscem
obscens
More Bat in fosso

CLINICAL FEATURES

Tender
Induraed
BHauony
uwelling in gkin
High ver
TREAT MENT

Excised ond pus is drrained

JTM STUDy MATERIAL

 Dr. JTM
3UREERN
PORTAL HyPERTENSI
CAUSES
POSTHEPATIC CAUSES
Right Heart Oysfunction
Budd Chiari Syndreme
AON
-NC Occlusion
1. PRE-HEPPTIC PRE SINUSOIDA
Posntal vein thrombosis
- PoLDogulopathuy

to cinhosis
INTR HEPATIC PRE SINUsoIDAL NTRAEP ATE CAE
Alcahale Mepa
Schistosomiasis
PREHEPATIC CAUSES
-Portal Vein Thrombosis "
Arteriovenous Fistula
Schstaelamasegtta
Canent
Congenitoal hepanic jbrosis Nene-ecnua
- Deugs
- Vinyi chlonde

Sorcoidosis

a. SinusoIPAL
- Ci99hosis
-

Polueushc iver disease

-Nodula
Metostohic
egeneuative hypeplasia
-

molignamt disease
4. INTRAHEPATIC PoST SNUSDIDAL

Veno ocdusive disecze

8. PosT- HEPATIC PosT StNUsoIDAL
-

Budd chiai
syndoiome

JTM SrUDy MATERIAL

 Pr. JTM
MANA&MENT

Acute

MR
cuppex

a l vooices
gaatoiointestinal haemorahoge ttom gasto -
is Common
oesophageal

manilearonion
. So ts anagement is longely peused en 1he poeverrion
so confoio Vicea
ad
m a n a g e m e n t
O hoemorahoge -

(poievennion
Phaomacological
oeduchiom opoial venous congestion
Vasriceal ligahon and seleothesiapy
V a o r i c e c a l

Balloon Tamponade

sTIPSS

shunt Surgey
6. Posthosystemie
Oesophageal tansechion

8 Secondasy poievenhion e vorieceal bleeding

COMPLICATIONS

.Vasvicecl bleedinq oesophageal, gastic, herss

a.Congeshive gastoiopathy
3 Hypeaplenism
4. Ascites
5. on dejciency anemia
Renolailutre
Hepotic encephalopathy

JTM STuDy MATERIAL

 pr. JTM 9URGER
SEcONDARIES IN
THE LIVER
tumor in iver
Most rmalignant
*

CAUSES

Cancer (Shomach, colon, Panureas.ki

.Abdominal
Hechum)

.Extraabdominal
Melamema, Ca ung, bloda
(Beast, lung, bladde
poiostare)
Testicular tumor

ROUTE OF SPREAD

.Hepotic asteouy -Melamoma

Poital vein - Casucinoid tumor
.ymphohicpoiead -Boueast, lungg

CUNICAL FEATURES
umblicaher
.Muthple, head, nodular uoith nodule showing
due to centonal necoiosis
. Ascires, jaundice
Loss o uweigh, apperite

JTM STuDy MATERIAL

INYESTI61ATION
LFT
. S atbdomen

TObiOPpsy
diver
laparosLOpy
TREATMENT

Chemoterapy

DIETLS CRISIS
Tis inheimittenkhydoionephrosis, common in calculus
hudoronephiosis Rollouoinq an attack Tenal colic,
beouchiorn OCuuTS due td stone uohich esults
in enlargement o pelvis o kidney esults in Ppalpable
mass loin
Alteneuo hours may disappea d u e to passage o
larqe quamtiy e Uine due to ejex polyumia

JTM STUDy MATERIAL 66

 Pr JTM
REERy
ORAL HOLECYSTOGRA
Test
OCC Grrahanm -Cole

Test done to shudy umehion o

he
gall bladdes

Fat ovee die ßor 8 days

soo m)
pevious night
Telepaaue given orally
tables (i tob oo
Toponoie aid
tore

plain x-TOy abdomen in

in euect
On
poshure
e day
is e OCC
oken to visualise 1he gall bladder

ater batty meal is given amd one more -Tay

-CY is
iS
taken to e e chonge in Bize e gal bladde
(Nomally should bë t6in ham poeviou tm)
) becauLe
because
gall bladder Contiacts on stimulotion uoit a
gtt i
ehc h men
meal
ga
6 it is umehioning nosmaily

Srnoot iling deteet Rgmijes Tom-cpaque gtore

Conoindicahion
Pahents cAvt sesum bilioubin > 3mg
Aute choleutis
Vornitin9

1A

JTm STUDy MATERIAL

SRGERY
Gall stONES
GALLSTONES
ONES
RE SMALL PE UKE
SUBsTANCES,
ES
4APLE OR SOLITARy,
m vT i P L E
occwR MNY WHERE
wITHIN THE BlLIARY TREE
MAY

PRetval
ence

107 OF OVER 40 rs
10 SILENT STOEs

R i S KP a C t o R s

m o R E I N F E M A L E S

AGE60yrs
o6ESITY

FAMILY HIS TOKY

pIABETES

IN CHDESTEROL
pIET HIG
ySE dF 0cPs
KEGNANCy

PathogenesiS

TEAATION 0F NORMH RATIO OF BILE SALT CHOLESTEROL

NOMALRATO 25
RATIO BELO : rLEIPITATION OF CHOLESTEROL.

INFECTLONS NFESTATIONS
- BACTE RLA E.coLt, SALMONELLA
- CLONOR x u SINESIS
ASCARIS wMBRIcoIDES

8LE STSS
DUE TO ESTROGEN THELAPY
PREGNANCY
AOTOMY
PATIENTS ON LONG TERM IVE ov TPN

INC&EASep BILIRUBIN PRODveTION

DUE TO AS IN HEREDITAEY SpHERO CY TOS1S
HEMOLYSU
SICKLE CEL ANEMIA

THALASSEMIA
MALARIA
CIRLMOSLS

JTM STUDY MATERIALS

 dun

Fmy Au
Al 4 nsti

A eun/ rdwrheqei.
hd-sterrod
Deah:deto
Murus
Glygadsin 1lelreserlinn
Cwalsstyiwnr

ACTOR AOUNED WITM 4ALL ToNES Fopma

TYPes
Cholesterol stones
LAG
OF TEN SoLITARY
VELLO, WHITG, GfAGN
MADL imn«LY 0F (MOLECTELO. CMoLESTER0L 1oNES

Pigment stones
SMNLL
FRINBL
IRREGULA
DARK
MMD oF BILIKURIN CoLCIum SALTS Di4MeNT STONEJ
SS TMN 20. OF CHOLESTEROL

Mixed stoNes
mvLTI FACETED
CONSIST of
CA LCIUM (ALTS

PlG MENT
CnoLESTEROL (to-Fo/)
&o As&o CIATED WITK tMRONIC CHOLE CY STITIS MIXED STONES

Saint's tRiad
GALL STONES DIVECTICcULOSIS OF LOLON HIATUS HERNIA

JTM STUDY MATERIALS

sURGERY
SHmPtomNS

IN
T
RIGHT OPER
UPPE QUADEANI,
FOR A FEW MINUTES To
sEvE&AL HOURS,
PHIN
ELT AFTER EATINA HEAV AND HIGH FAT MEAL

F E V E R

N A US EA

v O M I T T I N G

P A I N UNDEK RIGHT SHOULDERK WHEN WETING ve ARMs

J A U N D I C E

ACUTE PAN CEEAnTS

Management

nvestisations

VLTRACOUND

LomUTERISED TOmoGRApHy
tHOLE SCINTIGLAPMY (HIDA SCAN)
eACP (ENDoscopic &ETROGRADE CHOLANGLoPANCREATOGLA tY
BLOOD TESTS

TReatment

ASYmPTOMATIC NO TRE ATMENT E QUIRED

NON SURGLCAL TREATMENT ORAL DISS OLUTION THERAPY

VRSO DEOXY CHOLIC AcID)

toNTACT DISSOLUTION THERAPY

SURGICAL TLEATMENT
tHoLECYSTO STOMY
s08TOTAL HOLECYSTECTOMY
9PEN CHOLE CYSTECTOY
LApAROSLopie CH0LE CYSTECTOMY

AD
JTM STUDY MATERIALS
 .JTM
R

SPLENICMBSCEss
Rare condition
Healhy pahent having uniloculaY abscess
Lmosntolity 9Hale is 15 20

x mmumo compnomised, muhlocular

Lmohality 9iate &o .
Pouedisposing Boco
.Malignony
Polyaythemia vera
. doug abuse
.Hemogiobinopothy
UT
Most Common erganism tesponsible-S. aureus
Oier Oganisms esponsible
stneptococcus
Salmonella
eram neootive entemc bacilli

Rungal obsces is typically seen in 1V positive and

imumocompnomised Caused by Candida

Clinical feohumes
. Abdominal pain
. Tendermess
Penitoniis
Pouninic chest pain

JTM STuDy MATERIAL

 Dr. JTM

veshgahon

T O C C E C T

eacen

Uniloculo
absces
Drainage + onhbiohcs
Muthlocular absce Splenectomy drainage o
pper quadrant
Anhbiothu

JTM STUDy MATERIAL

 CLINICAL MCO'S

A S0years old with history of jaundice in the past has presented

with right upper quadrant abdominal pain. Examination and

investigations reveal chronic calculous cholecystitis. The tiver
functions tests are with in normal limits and on uttrasound

examination, the common bile ducts is not dilated. Which of the

following will be the procedure of choice in her?

a. Laparoscopic cholecystectomy
b.Open choledocholithotomy with CBD exploration
c. ERCP choledocholithotomy tollowed by laparoscopic
cholecystectomy
d. Laparoscopic cholecystectomy followed by ERCP

choledocholithotomy

Ans: A

JTM STUDY MATERIALS

 Dr. JTM
SUR&nERJ

GPLENECTOMY

COMPLICATIONS5
oHAGIE
EMORRHAGE. Mainly o m Bhont gaatiic vessels
Re-explosion and comfuol obleeding is
needed3.

G P S T R I C O L A T A 7 1 O N

HAEMATEMES - Oue to mucosal congeshion Lpllouing

igahion oshot gastie Yexels

EFFUSIOoN AND EFT BASAL ATELECTASIS

LEFT
cer SIDED PLEURA
SIDED

lobe atelectosis -

nmost common)
( lelt
SUBPHRENIC ABscESS
EFT

5
PANCREATITIS, PANCREATIC FISTULA

in wec, plarelet count

HEMAToLwGle CHPNGES- Rise
Rise in abnornmal RBc's

&GASTRIC FISTULA

COLONI INTURY
SIDED
9. LEFT

Post splenechomysephcemia
o.INFECTON
IPoRTAL VEIN THROMBOSIS
Vein thombosis
t2.
oVT Clate) Deep
thomboembolis-
to educe
Small dose aspiin

JTM STUDy MATERIAL

 Dr. JTM
SUReRRY
HyPERSPLENISM
TE is overactvity ob
hypercellular
peen
bone
causing
maiw. pamcytopenia
Pamcytoper
moe o
iin perisho
t
tine
S splenomegaly4
with anaemi
oit delect n
any
peopheol Cel
CAUsES
Pooal HTN
Porimasy hypersplenism
Malania
Kola a2ar

TB

FEATURES is one witk

Sgmphomatic hyperaplenisms
THanshusion dependent anerma

Tntechon
Epistaxis
Bleeding gum

TTM STUDV MeTERIAL

 D. JTM
SUR6¬RY

NNULAR PANCREAS
due td tailure o
Iqt
cotm p l e e 1ototion o
Hotat

cV e n a l bud b pancrecs,
veot 9ning5 Paereatic
1S&Le encircles he
Bo Rat

he 2nd
1SSue

nott duodenum
p a o I t

obstnucthion.
dausing
Annular
PancreaS
CLINICAL
FEATURES

Distension °6 upper
a b d o m e n

Bilious vomina

Visible a s t i c peistoalsis

I N V E S T I G A T I O N

abdomen -
Doublee bubble appearanc
Disin r a y
eRCP

RI Shudy
Bavium meal

TREATMENT

Oucolenoduodeno.stvmyy

Ouodenojejunogtomy

(should not 1 e s e e t the 9ting)

JTM STuDy MATERIAL

 Pr. JTM

AcUTE PANCREATIT
CAUSES

Biliay tvact diseage

Cabuse) juices
2. Alcohol toxicity stnic k pamereahic
gaa
3. Hypersecrehon disorderS
vascular
4
S.
Collagqen
ugs coohcosteroids

6. HypesMlipidemia
4. Familial or genehic

INVEST IG»A1ON

. Tncrease keuum amulase

Cleorance 9Haho
coiechinine
a. Tncrease
3. Typsinogen
acivohion polypephide assoay
4 Seium typsin
5. LFT
6. Plain x-Tay
. US, MRI, Chest x-ray
 Dr. JTM SURGERY

VARICOCELE
Oilatahon amd torBdusity Penis Dilated veins of
the spermatic cord
rompinilo Plexus
o h n s amd also
%Veins
esticular veing

Commen in tall t6in

Testes-
youmg men

Common in Let A varicocele can be felt A varicocele is made up

More
be bilaheral and sometimes be seen of veins that contain
Bide, can
as a tortuous mass on the inadequate valves
surface of the scrotum
ADAM
mocele Causes inereased temperature in seouohum
ndepresesPermorogenesis and 8o Cause
ineoht y CoTTecoble)

TYPES

PRIMAR 1DIOPATHIC

No cause ound
There is inompefence o valves o teshicular
Vein

SecoNDARY
ue to speilje couse

Aided nenal casicinoma in ) renal vein

Causing venous lou obstpuchion to teshicular
vein

JTM STUDy MATERIAL 62

 Pr. JTM
CLINICAL FeATURES

in 9oot o SCuotum
Suelling
and crotum
Doiagging poin in 910in
Bag o m s elng
Impule on cougning

91educed.
On ying dou it ge's

Bow Sran Ater holding varicocele behween

1humb and ingers, pament asked t
bou
in gize
Vaicocele geks reduced
- Bouing reduce he blood lou o
tesheulan vein and pompinilpim plexug
Causing 9Heduchion in Size
CaRADING
.Smal
a. Moderate
a. korae
4. Seveay t o t u o

INveSTIGATIONS

Venous doppler o
srohumm and guoin.
ultwaseund abdomen to look for kidneu tumour
Sermen malysis

JTM STUDy MATERIAL

 Dr JTM

MEPTTIENT
PLOMOS
o l 0PeRATION

ternal oblinue

Saguina
nal extwapemtoneal
aponeuroes

o n t e reshicular vein
s

Len gonedal

al approach

gubinguinal appoIOach uretaf

appouoach Let
Scrotal ViicOcelo

lapamoscopie appioach PALOMO'S oPeRATiON dang

dvded

JTM STUDy MATERIAL 1o4

 D. JTM URGER

TPES OF HERNIA
CLINICAL TUPEs

Reducible heomia
r e d u c i b l e heomia
Obstoucted heonia
4 Tnlamed heomiaa
5 Stoamgulated heinia

BASED oN SITE

Tnguinal heomia
Femoral hemia
3 Obtunaor heomioa
4. Oiophragmanc heinioa
s. Umbilical he04mia
6. Epigoutotic heonia

JTM STUDy MATERIAL

 Dr. JTM
URAeR

ROLLING HERRNIA
stomach
A poohon Rling (uaraAhqns)
ough hiaral hiatus her ria
mgoiare horacic covity,
into ww
pening is Domal
ni eE J u n c h i o r n

CLINICAL FEATURES

feeing ullmess or distoroprt

bullnes

sma meai
a
ayter
due to Compaegsion
Palpitahion

on 1he heait

due to ivitonion o
Hiccoughs

phrenic heoive

The Heniareds0c con

undeogo volvulug amd necHosis,
hence,
its a lije reatening
condition

Rolling
There Cam bee longitudinal Hiat us
Hernia
ukers just below the
heomriared Stomac knouon as CAMSRON ULCERS

INvESTIGTATION

Banium meal

MANAGEMeNT
AN pohemts need ugeouy Repair e sac ond Tepair
hiatuS

JTm STUDy MaTeRIAL

 loo'le.94 UT,no.91~ 1"91ack Obs\"9iuclion

• l.c,n pew,
• Fe.att..l~t,;:. ct b\adderc outlet obst"91uc.non
- lfeqµe.n~
- ~,ration
- st91eom

• kidne'ds. att. ~ten noc pa\p,.ble.. •~ ~ena\ --t,oHu"fe

d~elo~ .

o,r,no.,,,~ 't91ac.t. c~\"()1uc4ion

• l.mn pa,n
• MM>~ in lot n
• AHo.ck.& 'Yttlal CO\i c.
• ~exe. J
_ o\13u--no..
iforu-ru ot, <>(enc,.\ b°''uiye 1;ke
- e.,'('()G,
- ~ -C.lO~h

IrM S1ut>~ MArERIAL lAf

 ?Jr. J'fM

(on! "a-nv,,, ~"'9~P~ ~Ck1 O"n?. o,me.d ot.

c,.o1'\S.'- ... v,rc \<,ch· m-e. dot\e
ColJJ,e, i~ 19\e.O\"ed .

_ in co~itn\ Pur o\:£.c\91utlion,

..SfOS'ITIOO i c. ,e,egv-oent
ond ~edut.to'nt. pe"1,s uti~d .

A r,cu.)
t
is cxen~d ord Postenor

wt ct ~\v,s
~v\.S

a~mose.d in 11\e ~ t . ,
,s layer

- - - Antenor
laye,
sutured

p<>!>Hio'O

Anderson-Hynes pyeloplasty

JtM Stul)~ MATER\AL

 f)r. rfM

_ Dav,g T- tube u.teJYO~

_ ll\l"'-ro!l.~"f'ic. P\lcloplOJ.\y
_ £ndo.t;cop,c 1"3c,ot~£•~
..... '.In 811oreJ'C,I ~l!Jd1>tOYJC\'lfli)SIS

Ii'
u.,,tt',out ~ \ bo1fU1'C-
J
A.,~hon,w-19 kionel-1
opexotcd i,' C>1 $l:- , •o{,ter'
a rnon'°"6 o ~ 1!>
opex-ared
_ (=unc.nonn1q No"rtY10 \
- An<kKSOn
oper'a-non

flM S1 u1>~ MATERIAL

C L tN tl A L FEATURes
OF KocH,s ABDOMEN
 'f)r. JlM
~,
CoMPLllATIONS o~ .,
CHOLEQJSTECTO M~

PoRCELAIN fuALL
~LADDER-
.It is one (J.)hek-e fflll b\add~ ooa\l ,s caltilfed
bew.u.1e ob ~onic. ChO\~!ttms .

'.It is potenti'all~ maligriat)t

'P1o,n )(-YO~ :- gecn a,g opati~ed n G1B

,c T91eatment; :- Removed ei~ er lapal\"01•

me~

JrM S1u1>y MArERIAL

 1)r. f'fM

J)I A& NOS \S OF

J3RAIN .DEATH
pt'f10N~ Fo~ c.oNStDER\NG, A ~•~&1Nos,~
-
~fl~
e11t ,s dee.p~ cm-noooee : ·
,iie r'tl n'll,lf.t be. no ..&..u.pisioo 'tt-.at u:rroo.. \s. due. -\-b
0. ~ ~ , i t , d9~U~
mio. )!\-"lould be. b(c.luded
t> no ~~w.nd o..bno,--m<l\i~ % ~u-m
, e1ecto1ot~tL. ac.id bcu.e bo\a'Y'lce. l!N" b \ood
\uc.ose. ~f1>'10ti<:m no..s be.en e.wud~
8
fO"e,)')t iS n)Q\Oto\ned O'n VC'rni\attn bec.aUl.e
,.~ ui. Q\el!.{>i'romon l,ru. be.en inocle.qµa~

l»l~ includ,~ neu910rnu.\wJo.,, b\otk,ng °96lh tl'lu.it

3 \,O.ve been eltluded

4·
it1e di~ S 'ttie disordell 1eoding cto b9oh·) deotf)
been i)i91m\~ es\'obHshed

5 ~ t be. no dcub\; 'ttiat. ,w,e, ~ent ,~

~•,W?~in.9 i'nexY,ed\O.b\e ~\'91UChl"fn.\ b'ro,1'>
~e

TE.STS Fo~ C.ONt:'1feMA'T10N

t At1 b)-o,o ste,m 94eYexa o-.e.. obseKlt

o.. 1ne. pup,~ o.91e ~·,ccd o.-nd ,'\1) "Snt.
b. 1he. to'rne.o.\ 91ef:)exo a-tt.. ab&eo~

}TM S'fut>y MArERIAL

 'f)r JfM

JrM Stub~ MArERIAL

 1)r. ff M

CoMPLICATtoNs OF
lHYRO II) 5 UREnCRy

VtNESECTION
in
1<
!Ocedutt~
'.It is o. C.Hl)ic:.a.l \»ett
1f>e. t-xie.mato1og~ ..g -."9
._ Re mova, o.. \'Oh.m1e ot,
1
11,eiyopeu-tic. ~ + io n
bl oo d ru. ~t "f 'O e. nt c(
,
~ to ,n bl oo o d, st rr d~

ft M S1uby MATERIAL
 f)r. rrM

,09 irom m,gc.uloo,po\"lC.U.9\ottC tc~ex cof

« bel()IJ.) 1{\£: ,eve\ ob umb,hc..vJ., u
:n: o,~\ ate.d ,, ro."<d , t,,t9tar-no..

More ocOJ.:"tS ,n ux,me.n

"',_ (.Dmmoo ovex de! abdom \no.\ s~

As&oCJoteo w,~ to~Ha \ po\~~ '\$ c..o\cm . ( &O"fd ,

~,! g, I
.iriVtS 61 ATlON.S ~~r.

Bo94, "«> er,exno.

.,. ~•m~
t- Abd.omen
i-' MRI

TRfRiM ENT

-k USde ex.t.1s1or ·h.xroou.rc

o.:i.1i-, 'l'l'O'fS, n o .s cxo ,$
OlCJ'rS W\~
ploc.eroent. mesh -to
ob:i om\ no I de~r.t

MOG\.S :- Su\inda <t

1bmox ,~n

J'fM S,-ut>~ MATERIAL

 ~t.JTM

EMBOLELTDM~

CouRvo1sER·s LAw
:I:n ponent. u,,tt, 'J'ou'Odic.e. ib 'W,e:ce, i~ palpa.~ tpH
f. o1addex, it is r£>t ck1e +o .8tooe.i .

rs, S4'-one d,5e.CU:e~ 90\\ b\addeT ,~ c.on~acted,, ~b91onc..

tr ord ron &s\"et\S., b\c .
.,. Ru\e not u~\ ,n AbSen(.e. ot, .90\\ b,oddesM
Tn~o.hefOtic. 9'1\\ bkkidCT
~ev,ous. Chdc~te.c.~

JfM .$1uD~ MATERIAL 2 s~

 ER~THROPLF\5 \A ()\:
~UEYR f\T
fbae.t-s d,se_ru.e ob penis
-tc A pe-.OlS,~m,;t, ~ed, «xoUJ lesion Whleh ,s
c.onCMion ~ttn,,

PiBDOMINAL
(
PAR~(E NTESIS :

-tt is o. srop1e., bedside. e~ c\'\rncn\ ps>4oc.edu:re \n

~h\ch a \1eel'J\e \nte.91te..d into ~ , ~ \ c.o~,~ o.-nd
o.suic.. {,'u,d ,g ~exnove.d

iii
]TM S1uD~ MArERIAL
 EtTRADURAL
HAEMORRHAG. E

<;kull

EBM o~s r

• Mio -½91o-os;enl:- _toss 0{, ~ o w . ~

totloU'\-n9 o.. h,s.~~ ob ta\\
Patient !toon ~!fAin& C..O~ ow~
Of!P"t'O ~terc (b-l'l.h-rs) S~ts
dett>'riat"\t19 I..Utl'D 7Nfl!RVA L

• Conbui.;on 19-\91\robih~ , dS>1owsinEW::. 1

1-\e.\"O\~ i s

, 1-\ukhinsonio'rl pu~ \ see.n

IrM S-ruD~ MArERIAL

 1)r. JiM

ErttER
e.e,.nc-,-o I (\nae!.W1€-S,o.
-k Ano.-u1f')e..o\1c. aaent. __,. volatile ona~it)etiu

+; ::rt ,~ ,~~,·to:nt, u~1eo.ro-nt ., f>\o~b\e

t: Comment~ ~ed aeent.

CAUSES OF NIPPLE
.DISCHARGE
1 Dutt po.pillorn~
~- CD.. c(, tl)4east
&aloct'o'r'ronea.
4 Duct etla!.,o..
5 . ~d,opaW,,c.

IrM .S'ful)~ MArERIAL 151 1

 1Jt. J1 M

l:t~YESTl 61A f \01'. S

•
c:r che&t
• Mfll
• fa911um su,aHOUJ
•
• &,dosoop~

TREMl"tcN'T

• 'Re!m'ls~uction ~) 1t9ooon o~ abe.no.nt:. 91~ SUbclQ~on

094~~ •

J-rM S1u1>y MArERIAL JS4

 1J• fl M

FLAIL CHEST
,,
f~

'
"'l N \
lfh\'K c\<'K'rt1 \ P\C~,,I\' 'I,()\'
• i I\~ I -"ll 'I CN
• ~1tnt0.~"' \ \' 'll Al f\\ ,
{\",~l\.\{\O\ ,,,oVC\"i~' ""' "
: i\ ' "~'..,.,«"\"~ r on\,, f ,o,'

• """A't.l\"l 1 • h,
'"° '-' r "~'"r' ,n'O<l?•O\
1>n\ ~,'('( 1n
• t.olt!.!'1-el\
~(lij!N
• (bsl{' '\ O)
1
-I" F101 I ci-ut (»,eve.nl1'clj l~j o\')l,l~h fl f>Oi<!JIJ:-1 ~ 4l- t'M!II' it
t,ondt. o,-.d ctoll'IU 1111,

~vE;t.i Ie.ATION~

• CJ(R
• S\ocd 9940U\)'---9
" Asattu'O\ Pc;a. "' p CO:i,..
• ~LlTO etco~o,~~
'l'REAf~N T
 ~t. rrM

TREA'f'M€1"T

• 1vF c.o:W·,et~!iOh'on ,# O'nt\bio\iu. , blood. ~ ~, on,

NU™\-\ion(l\ t!a.~ ~ t .
• tJrero.\ ~tis.\on a" ...&\ou9'h

ftM S'fUI)~ MATERIAL

 r. JTM

,
0
1
t llfl\

!«IiF1~1ULA

M (111\U t/\l
QQSlP\JC.TIOtJ

• Abdoin.,,nc, 1 ?O'n .
• Fea-tu,e,:. ob ,ntu. \inol ob~t91uc.ho n
•, ~,to
Rew-nttis
rtent epsoct.,c. o~t91 udiO O - TUMB L1N6 , ~T°RUC.11()~

:IN~ESTt61A 'TION

• flain x-TO~ abdomen

• OSGi
. a scD.n
TREATME:NT

flM S1u1>~ MArERIAL

 i>r. r rM
--- -~ SIJRG,eR~

Gooos-ALL's Rule
Good sall's Rule
Posterior cor111d frac.ta

• •
~n1 v1r 11 •na l llne

,•

•
,•·

•
An terior: straight tracts

D e R ( U M's D1seAst
;. Adi~ C l (x) IO l'C l!il Q

tti pl e lipc,r-notos.1s ITIOinl~ Ae en in °f pn ale.i.

1 '.11, is rro
-t9.unk, E\i"l'dle&
, "fmler< ffit. dl!\X'Si-tion ~ a l\ ~ in
1 in ~\ \~ c . , ~, a\ -9 ',c .. ~em

J' fM S'TUI)~ MATERIAL

 '/Jr. JfM

· b9ieaAt
f~~.,to10p~ of, rno
1',on tur.uo1
due :t,
intKe.Obe io dudo1
~ v e ,t,$ue e.1eme.nts

,- can be u~lat~I J,, bilateKGI

Non p¥1ol°91calstimu,a~~y
oat9'0.9en ex~
(er<) .
.1nh,bi«to91~ ard9103en d~CAe'W"'I~

ca,Jg€S

Oe&~ ~ exCJlM
Ard9fo3eo det;ciero~
0
iu-hc.u..la'Y -f..ai lure
,

I< ~uss -Anabo\"ie ste9ioid

(eBeseN1"A'TIOW5

;. Oaij:µle en,argerment ob b~e.a£b oc.cup~':9 011

q,µach'0'\1ts
-t( u?ell loe!.ohied., A!mO\l f,i91ro,, ~ d t>odu1e u'ndet< crreo\o
4wo ,xi,nbull,, ~e.91

'.REATM€N'f.

"' CJ~wm 0.91eota.,y inc..(g,ion

t Re.duttion motnrno89to .p~
N\pple 4- AU"'9eJnU
I< 0>1ugs. :- 1amo?<i\)e.o., ctom,phe,t>e, ., a-od9\ogen&

r-- -- - -
Jr_M
_ s_,._ub~Y_M_A_r_ER_1_A_L_________
 1:)r. rrM

)1 e:MOPT~515 5
EMATf.M£S 15

c,ou9h ~c. Ch . •)r NO.U !eQ ,.. Voto m~

r,e.~ s , s
¥
r~cce.cu he.rne.te.rruis
F"9f0Wl~ ( l.. or.-) Not

A\\<Q\,ne pH Acid,c.. p~
•
M\~e.d ufrW, 'It Mi,ced witn gtod
mot9 'oph ogu ne..ut s>1~ i \~ f C!»i•ticl~
t Mele.no. otgenl::, * Mele.no... ~ t
.,r Eit~ ht 91~d it ~k . b9t0 t0n
( ~id ~ma +in)

~ ,o \A ~o Y U ~ i ~ -; ~'-" O~ HI o Pul)
d,seo he

JrM S1u1:>~ MAr ERIA L

 encs
€YE OPENING,

.. ,o,o
• Spcomneo ~ -
P-.peec.h -
i
pa,n .2.
• None. \

VERBA L- RES PON.Sf

• l!)9ue nted - S
• eonbusect - 4
• Inapl)s>1op01 ,ate
• inc.omp,,e~ i b\e
• None.

MO.,OR R€S~SE

• 0~ tom~ - 6
• wro\iseA po,n - S'
• F texion -to \)O;n - +
• Ab0c»1mol {,\exion - .3
• Extension -to pa,n - l-
• None I

TOTAL- SC.ORS ·.- \5'

Maid ~d 1~W1~ sc..me :- •~ -\5
Mode.,w-are :- q-,~
Sew~ :- < (a -a)

I-rM S-ru1>~ MArERIA L

 1)r. rrM

fNDIC:ATlONS OF
TR~C\-\EOSTOM y
~--- ------

INVERT061RAM
i 1.1: \S o.n ,<-m ~ invu .\i3a <tio '1
.J,
n ~hi ch me\"a' c~e.c.t, is to ~ ove.."C
.: Aro' d;~ \e.,, ch,t d ig. ~d ~id e. dow n
~h\ le ~-"l" O~ is
tmde ob pelv,s. h, \areira\ p91 ~ec tion

Use.d on\~ d"' hl-s (en')

~c h di£ro.\ ~ec tum
'O"OY'e. ~\"'eJ'C bi91W)_. o.1. 9ai. needs. ..tt,

J'fM S1'ut>~ MA-rERIAL

 VASECTOMY ",'If·-- ,/''
• E~ i >\
-

«I'NO\c.A1' tON5

COM~\CA'f' IONS

• He"'°°' to~

. ~~""
• Hoernotoc.e.lc.

• C\.toce.1e
• Spe.O\ -n 8 9fQ~J\OY°OCk

PANLOASf TuMORS

PRE'IENTIONS

1. ~ey b94001,~\ plexu.A palb~

'"'°9,nerc'.! S~nd~oroe,
.3R,b e9eos.1on
4 Apco I ~hodou:>

JfM S1uD~ MArERIAL lO

 1)r. JfM

KRL>KEN BER& TuMoR

IrM S1uDy MArERIAL

 1)r. J"fM

IscHtORECTAL ABS(Ess
I ll\r I t hln I r1
fi htlil
l1p1 , phtn I II
II tul,

1, '"' phlm t 11
fat11I I

lfll!'r phln nerlc

11~1111 I
S, l mt 11 i

l lllll lCllllS h I I

CAJS€'S

-to c11: teru: ,' r, <:(, loWC'l° 1nll>11m1Ul!,c.ul09t onol obs~

-tt (lo e
Con be bk ttt 09, l~mrro-h'c. ho9
1n
f'1crre. --got ,n to~o.
CUN,C.AL FfA'TUR€S

Jc "fetxk.~
;. ~rdU"roted
*.,. B9-to.w~
&u e\ \ •~ ,n Sk in
-JC H'9'1 be.veY
~M €N T

Excised otxi PU!> is ch -u i~

 f)t. rrM

S~NDROME

Mallory-We
tear 1s a tear In
th" mucosal lay r
Jt the juf'l( n
. the esopt IS
and sto h

tt'REATM€NT

i\ood ™a"<\A\y-Aion
1 !VF> Sed o\ion
PRxnostotic~c,o\"s - VOU>ps,,e.i,n
erdO,W)?iC. \ruectiOO h,ro.~
£uirs~~ (,9'o."reA~ ~~,"fed)

]TM S1u1:>~ MArERIAL J.6'

 g\l

VoN RECl<.LINHAUSEN's
p,seASE

tJ
}j

JrM .S,-uD~ MArERIAL

 '/)r. rrM

MONDOR's ])1SE~SE

on C)j c\Si"9 '\ne- 001m oboVe

t'()..oeto...O:, A'"'°\\ou, , ...&J.bw\-o.in eo~
c~ocNe ap~O,, a\ors ,.-!ride 1ne
c..crro hke ~~O\"'O'bOse d v~n.

_. ~ d i O \ ' i cl, tnOVe,meJ'O\:s

,.~wue.
1t Arm- ,nb\(l't'(")rroto9'~ d9\u9!> needed

T1"M S,-uD~ MArERIAL

 1)r. rrM

Mucoc.ELE OF APPENt,x

O..tNttAL. F€A -JR(~:,

it Coliek1 po- '1 ir'.I 91,9nt j Iiac.. ~ a . ,

,eroeiroeM 1n 9iight ihac.. -f,Ot!:SO..

.H1G.H ANAL FISTULA

... Ht_g'n le>,,e\ t,,s-ru\M im-o ana\ ama\ at ar a'wtt
"">termcll 9i,ng
!J...'N\C.Alr FfATURt~

• ~opu~u\ent d , ~ e ,
• Sk,-,, ,919Htahcm

JrM S1uDy MArERIAL

 I

"1-c.ROT\511\lG
r~E. £NTE((OCOLI r 15

1 9\\n\rxil ,\curt,
Coetino
() tr\ ,dh 1r1 , r11c,n
~nhre ,!, no\, b<)u,e.\
'.[r,el/JCl'lle , - f\".•.ot ,,1\~d , ,•,I\~, I 1'All 1,,1 ,et
• tto I \'t?WHt.'>"'o
\0 I 'tc>~W) \ ,o\ I\('}•

. • ~PoX\0.
• tkn\J\Hro.\ 0?1l~?-i~ conf'u\f.)'ttOf,
• hvl il)"'ljfl 1?10'1V.. J1.,m1
• \lj\.>l'9-\0r1.'\00'0l'C ~.J.
• ~~pow-ie~.-f>ln • f'orked cl'\\ ''?-10"f\(.Y.,1.i1Cf0
, H~poten!.,o"O • 0 Vtt'{OO!.l>f3Q tJ.",l"W, eo\c,UJ'J"n
• ~odOS\~
/ o»IOI/0' ,1'111"5
. ~~pe"v,~c..ct!.'"
Me,ietiH'Jnc. ~ (\)C."fOio..
-l,
&deJ'C"<l\ ,rrvoLio'<> o\, twC.OW. a.. bou->e\ u:)O\\
.\,
Nec.9109.h~ - .s\-\\n \tsion &. or W"<
-1,
Net ~Otl5\f"S cti~,.ocol\·~"

J 1M S1u1>~ MArERIAL 2~0

 '[Jr r1,v1
I
"' ' ,r,. l ' 1Ut~ vi ,
• vor"'' 1
I)
.I I\ Oldt.11,',\
t
fVJ\
.,
' \ u-o\\
and C(}CJ(-; ,r, v..1~ ,J,
,'t)(l \ \) \}IJ4, l I

@O 1

• :e,tood

• St9hc..tu...-e - srro\, toJ.,e\

• Pe9t(51roHcm - f>e9wto~
• C..0100\C. ~~,c.~ toin de..ve\o~ late~ he0~"'9
,~e cne.o.. ( ,01 c.o..tu)

J-rM S1u1>~ MArERIAL

 - • • I

j}r. ffM 7

-
• rr.-..a,c.o-non6 - pneumo~-tt>ne.um
_.1.1-iu _ obdom,na\
- di\a~ ,ntut\na\ loo~s

-'?.Hoc.ed~
 'f)r. rrM

R LYflC ILtu

t t.• N 1U\ L FEATURES

f No passa,qe. blOnu.
• No toLOef .sou:nd.J.
• Mo.94ked abdo.-rnna\ d,stens1on
• ~rti"'9 lairge volu ~ b'u,d
• 1a~~dkl
• Oul\ abdcm >1nol pa,n

JM~A&tfMENT

ie ~Mion& :, ~um eled'01o\~te eA+imation

SC&t
~-Ta~ abdomen
use, obdome,n

J-rM S1ut)y MArERIAL

 1) r. rrM

---- RUPTURE URtTHER

CAUSES
I. ~o tio \-e .d w,~
\Y"lj~~
~S .~U {'{ )e. '{) ffl \
re,\v,c. ~c .du --c -e, du e --to R'f l:~
~ . C. a\ tu \~ ~se
~ - P91o\onge..d \abcik"C"
ca\ne\-eJrisancm

CL I N 1<.AL. fE A1 UR ~

• 'B loo d in eJ(\e'cno\

• Fo,\tree m- d~ ,w \~ m
• Sh oc k w""' "°'loY"
~ ~ d ,o .. , ~ ~ n s_,on
j
~,nc.
• & ' 9 . a v ~ o\, u ~ --\'o SC 9\0 -hx m, pe,t,ne.u'\
t,. n\ \ "C) , obdOT'O\r,a \
 PSA

'P-RNTALOON HERNl~
., 1 ~die " Rorr>beK-g he94n;o.

1 [)()\f., d191ec,t and indi'l'ed: iT19Uino.l [email protected] Ott

th
~ent, °'c.a\l~ J)94uent ~,rett he.C>,n,o..
It l\u
'?30.1.~ media.I a.rd latel(O\
~t"es>,~
~u. ..&tmddle 1flc i ~

1 fin, ... _ ,•~ n

~e.w'°rreA')\:, ~,·a_

J,-i-, Sruby MATERIAL

 1)r. rrM

TRANSIENT l5lHAEMIC.
ATfAlK
~)S£l -toc_o\ neu.9,0109,c..o.\ ~ t 9-\elo\\/~ ~~,n
' "u bQU.l\"S

'MettiAN\~M

10 pto\"e.\et se~n.9 disloct9cl b94m"n

r olf-e-to~c ptoqµe 'h:> c.aw.e. J!>~t e\:s"'udion
ot dlS\'o\ bm'\"'JC.h .

TRfM"MENT

~ent w,"n head ob bed i,\at

(SO -to ,~ blood ~loOJ +o b--ro\n)
f ~gh ~u;.~ - ~mmed,are ~p,~n
F ~ ° " ~ ~ t and ,nve.&tiaatioo
~mp1ote\e.t
- Aspi~frn -,~ - 200 ""t9 ldo.~
- Ue>p4idogire\ 7 5

Corm.non q, ~is.le. t9d'cfeu - f4TN .. ~M .> 14~pe94Hp,demio.. - stating

~Wtct d,seo.!.~
• U!~ O'O S\""00~\f~

JrM S,-ub~ MArERIAL

 ,pr. ffM

co~trtid ~~,.\o9,~ "1 , "

Co..~o~, t'\
i f:ndO'Y te.J'l"'C..U"O
c~ond ~ \-e.'\'\J ste.nti'"S

JTM St Ub~ MA'f'ER\AL

 'J)r. rrM

5PONT-AN£0US
NtUMOTI-I0RAX
"' ~'('()0.91~ Af:Ont'Oneou.lpne.umo1nomx iq. on obnoxrcn \
ac:cumu\otio'Y"\ et, oi<>, 1n ~ce. \::eh.ue.en lu-nq~ t
c.ne.t.e c.av,~ ffiat 91etu\t in pamia\ aind c.ornp1ete.
c..o l \apse o(:, Iu'rlq

(:)Je. to ma-hon ob ,,g«->a\l .)3au. o(, Jl9' ( eilet:6) n

1on9 <h~ue. 'WiaL 91upw...-e. caw.'Y'X) a,o/1 -"'D erJ. ..,
,nn, ~'\e.urro ~t° c..e..

~ -1"eumothorax

Pleural ~tte line

]fM .S1'ut>~ MArERIAL