(BQ) Part 1 book “Surgical diseases” has contents: General surgery, jaw and oral cavity, neck and salivary glands, thyroid, parathyroid and adrenals, breast, acute abdomen, peritoneum and retroperitoneum.
Jaypee Gold Standard Mini Atlas Series SURGICAL DISEASES System requirement: • • • • Windows XP or above Power DVD player (software) Windows media player 10.0 version or above (software) Accompanying CD ROM is playable only in Computer and not in CD player Jaypee Gold Standard Mini Atlas Series SURGICAL DISEASES Sriram Bhat M MS (General Surgery) Associate Professor in Surgery Kasturba Medical College Mangalore Karnataka, India e-mail: meera_sriram2003@yahoo.com JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672 Fax: +91-11-23276490, +91-11-23245683 e-mail: jaypee@jaypeebrothers.com Visit our website: www.jaypeebrothers.com Branches • 2/B Akruti Society, Jodhpur Gam Road, Satellite Ahmedabad 380 015, Phone: +91-079-30988717, +91-079-26926233 • 202 Batavia Chambers, Kumara 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jpmedpub@bom7.vsnl.net.in • “KAMALPUSHPA”, 38 Reshimbag, Opp Mohota Science College, Umred Road Nagpur 440 009, Phones: +91-712-3945220, +91-712-2704275 e-mail: jaypeenagpur@dataone.in Jaypee Gold Standard Mini Atlas Series: Surgical Diseases © 2007, Jaypee Brothers All rights reserved No part of this publication and photo CD ROM should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher This book has been published in good faith that the material provided by author is original Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s) In case of any dispute, all legal matters to be settled under Delhi jurisdiction only First Edition: 2007 ISBN 81-8061-981-8 Typeset at JPBMP typesetting unit Printed at Ajanta Offset This book is dedicated to all my patients whose trust and love are beyond comparison FOREWORD What we have to learn to do, we learn by doing —Aristotle This is exactly what Sriram Bhat M has learnt and has put into practice by the two excellent books he has already authored—one for the undergraduate students of surgery—SRBs Manual of Surgery and another textbook of surgery for nurses—SRBs Surgery for Nurses His latest contribution is Jaypee Gold Standard Mini Atlas Series: Surgical Diseases This is an innovative work, having photographs of both common and uncommon surgical disorders with a brief summary of the salient points about the condition The belief that, a photograph is worth a thousand words, is exemplified in the work of his, which is short yet informative, brief yet complete, designed specially to leave a long lasting imprint in the readers mind I am sure this book will create a niche of its own in the armory—both of a student in the process of learning and a practitioner who still has the zeal to learn I am proud of the fact that a student of mine has reached such heights of excellence and I feel privileged to be given the honor of penning the foreword for this unique book I wish him success in all his endeavors which I am sure will be an inspiration for every young aspiring surgeon Thangam Verghese Joshua MS Mch Head, Department of Surgery, Kasturba Medical College, Mangalore 575001 PREFACE The surgical conditions vary in presentation from place to place Some of them are particularly common in particular region My 15 years of teaching experience has made me keep thinking how to make this subject more interesting, easy approaching and remembering The local government Wenlock hospital where I work as honorary surgeon has given me immense opportunity to collect enough teaching materials which I have compiled it in the form of an atlas for a quick glance Each picture has been provided with a short summary but for further reading concerned textbook has to be referred I thank all my patients for their kind co-operation which enabled me to bring out this book I also thank all my teachers, colleagues, friends, students and my wife Dr Meera Sriram for their help to bring out this book in time I hope this book will be of help to many students and practitioners Any criticism and suggestions are wellaccepted Sriram Bhat M CONTENTS General Surgery Jaw and Oral Cavity 87 Neck and Salivary Glands 99 Thyroid, Parathyroid and Adrenals 113 Breast 129 Acute Abdomen 145 Peritoneum and Retroperitoneum 159 Liver and Gallbladder 165 Pancreas and Spleen 179 10 Abdominal Wall and Hernia 191 11 Oesophagus and Stomach 209 12 Intestine 229 13 Rectum and Anal Canal 241 14 Thoracic and Neurosurgery and Urology 255 Index 289 / Surgical Diseases A B FIGURES 1.1A and B: Paronychia Figure 1.1 A shows acute paronychia with visible pointing pus Figure 1.1 B shows sloughed area after paronychia which is granulating Acute paronychia is the most common hand infection caused by Staphylococcus aureus and or Streptococcus pyogenes Severe infection can cause suppuration around and under the nail leading to hang nail or floating nail Throbbing pain, severe tenderness with visible pus are the features It needs antibiotics and drainage for fast recovery Chronic paronychia is due to fungal infection which often causes destruction of nail, itching and recurrent pain General Surgery / FIGURE 1.2 A: Abdominal wall abscess FIGURE 1.2B: Aspiration of abdominal wall abscess FIGURE 1.2C: Cold abscess loin Figure 1.2A shows typical abdominal wall abscess, which is well localized An abscess is a localized collection of pus lined by granulation tissue covered by pyogenic membrane [containing pus in loculi] All abscesses should be confirmed 150 / Surgical Diseases FIGURE 6.4: X-ray abdomen showing ground-glass appearance in peritonitis Figure shows plain X-ray abdomen with ground-glass appearance due to peritonitis In perforation, gas shadow is seen under diaphragm in 70% of cases In 30% cases and in primary peritonitis gas shadow under diaphragm is not seen Immediate laparotomy is required Acute Abdomen / 151 FIGURE 6.5: On-table look in acute peritonitis with frank pus in peritoneal cavity Large amount of pus was seen on laparotomy in a patient with acute peritonitis Ileal perforation was the cause of perforation Perforation was closed and abdomen was closed with drain Patient recovered well 152 / Surgical Diseases FIGURE 6.6: Ischemic bowel necrosis Figure shows localized necrosis of bowel due to ischemia Such necrosis may be due to localized vessel thrombosis, infection or adhesions Such lesion leads to perforation and peritonitis and so always needs surgical resection Acute Abdomen / 153 FIGURE 6.7A: X-ray showing multiple air-fluid levels in intestinal obstruction FIGURE 6.7B: Intestinal obstruction with dilated bowel 154 / Surgical Diseases FIGURE 6.7C: Intestinal obstruction due to a band Patients with intestinal obstruction presents with distension of abdomen, vomiting and constipation Causes may be hernia {inguinal}, adhesions and bands, worm obstruction, carcinoma, tuberculosis, volvulus, congenital anomalies and intususception Plain X-ray abdomen shows multiple airfluid levels Treatment is laparotomy and release of obstruction and if needed resection and anastomosis Acute Abdomen / 155 FIGURE 6.8: Roundworm obstruction-worms being removed through enterotomy Roundworms causing bolus obstruction is not uncommon It is common in Asian countries especially in children It is initially treated with drugs (albendazole, mebendazole, piperazine citrate) and conservative treatment If obstruction persists or complications like perforation and peritonitis sets in, laparotomy, enterotomy and removal of worms with peritoneal wash is done 156 / Surgical Diseases FIGURE 6.9A: Small bowel gangrene due to mesenteric ischemia FIGURE 6.9B: Small bowel gangrene–resected specimen Embolism is the common cause for superior mesenteric artery ischemia It may be from heart, aorta, endocarditis etc Often thrombosis also can cause ischemia Gangrene is extensive involving most of the small intestine {jejunum, ileum} After resection hardly any significant length of small bowel is retained, which eventually leads into short gut syndrome Acute Abdomen / 157 FIGURE 6.10A: Dilated sigmoid colon in volvulus 158 / Surgical Diseases FIGURE 6.10B: Sigmoid volvulus-on table finding Volvulus is twist of a segment of bowel in its axis Commonest site is sigmoid colon It is common in Asian countries Volvulus in sigmoid colon occurs in anticlockwise direction It presents with absolute constipation and distension Tyre-like feeling of the bowel is typical Plain X-ray abdomen shows dilated sigmoid colon—omega sign, coffee bean sign Flatus tube insertion is tried per anally in operation theatre to derotate the sigmoid colon If fails, immediate laparotomy and untwisting of sigmoid is done If sigmoid is gangrenous, resection with exteriorization is done 160 / Surgical Diseases FIGURE 7.1: Mesenteric cyst Figure shows typical chylolymphatic type of mesenteric cyst It is common in ileum containing lymph which is milky colored It is unilocular, thin walled congenital cyst which has got independent blood supply Enucleation is the treatment Presents as mass in the umbilical region which has got mobility perpendicular to the line of mesentery Other type of mesenteric cyst is enterogenous one Peritoneum and Retroperitoneum / 161 FIGURE 7.2A: Psoas abscess—CT picture FIGURE 7.2B: Psoas abscess—on table finding Psoas abscess is commonly due to tuberculosis of spine or pyogenic or due to suppuration of hematoma Patient typically presents with psoas spasm with inability to extend the hip and hip is in semi-flexed position Pain, fever, mass per abdomen are the other features U/S abdomen, CT scan, X-ray spine are the necessary investigations Treatment is antibiotics and exploration through lower loin incisionextraperitoneal approach and drainage of pus Pus should be sent for culture and AFB staining 162 / Surgical Diseases FIGURE 7.3A: Retroperitoneal tumor CT picture FIGURE 7.3B: Retroperitoneal tumor—on table look Retroperitoneal tumors are usually large, not moving with respiration, nonmobile, does not fall forward, deeply placed and resonant on percussion Commonest malignant retroperitoneal tumor is liposarcoma It causes backpain, hydronephrosis due to ureteral compression, varicose veins due to IVC compression and palpable mass per abdomen They are commonly inoperable Treatment is wide local excision, debulking surgeries or radiotherapy / chemotherapy Peritoneum and Retroperitoneum / 163 FIGURE 7.4A: Ileocecal tuberculosis—X-ray finding FIGURE 7.4B: Intestinal tuberculosis 164 / Surgical Diseases FIGURE 7.4C: Intestinal tuberculosis FIGURE 7.4D: Tuberculous mesenteric adenitis Ileocecal tuberculosis is the commonest type of abdominal tuberculosis It can present as mass in right iliac fossa Enteroclysis and barium enema shows raised up cecum due to fibrosis, obtuse ileocecal angle, incompetent, thickened, calcified ileocecal valve, narrow ileum, ulcers and strictures in the ileum Figure 7.4B and 7.4C shows multiple tubercles in the intestine Figure 7.4 D shows caseating tuberculosis of the mesenteric lymph nodes ... 23/23B Ansari Road, Daryaganj New Delhi 11 0 002, India Phones: + 91- 11- 2327 214 3, + 91- 11- 23272703, + 91- 11- 232820 21, + 91- 11- 23245672 Fax: + 91- 11- 23276490, + 91- 11- 23245683 e-mail: jaypee@jaypeebrothers.com... Adrenals 11 3 Breast 12 9 Acute Abdomen 14 5 Peritoneum and Retroperitoneum 15 9 Liver and Gallbladder 16 5 Pancreas and Spleen 17 9 10 Abdominal Wall and Hernia 19 1 11 Oesophagus... Ahmedabad 380 015 , Phone: + 91- 079-30988 717 , + 91- 079-26926233 • 202 Batavia Chambers, Kumara Krupa Road, Kumara Park East Bangalore 560 0 01, Phones: + 91- 80-222859 71, + 91- 80-22382956, + 91- 80-30 614 073 Tele