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Manual of Surgery
Sumit Chhikara, Anupam Kumar Singh, Sandeep Kumar Thakur, Pardeep Gupta
1:
Parotid Swellings
ANATOMY
Important Structures in Relation to the Gland (Fig. 1.1)
Causes of Parotid Swelling
Clinical Features of Parotitis
Tumours
Epithelial Tumours
Non-epithelial Tumours
Pleomorphic Adenoma
Adenolymphoma
HISTORY
EXAMINATION
GPE
Local Examination
Inspection
Palpation
INVESTIGATIONS
Differential Diagnosis of Parotid Swelling
TREATMENT
Parotitis
Pleomorphic Adenoma
Benign
Malignant
Adenolymphoma
2:
Ca Oral Cavity
HISTORY AND EXAMINATION
Age and Sex
Ca Tongue
H/o
Local Speed
H/o
Metastasis
H/o Cough Hemoptysis
Examination
Inspection
Lip
Site of Ulcer
Palate
Gums (Gingiva)
Floor of Mouth
Cheek
Palpation
Lip
Tongue
Palate
Gums
Floor of Mouth
Leukoplakia
Erythroplakia
Chronic Hyperplastic Candidiasis
OS Fibrosis
Plummer-Vinson Syndrome
Sites
Floor of Mouth
Gingiva and Alveolar Ridge
Buccal Mucosa
Hard Palate
Death
Staging
Investigations
Management
Surgery
THERAPY OF NECK
3:
Thyroid Gland
ANATOMY
Deep Cervical Fascia
Investing Layer (attachments)
Pre-tracheal Layer (attachments)
Surface Landmarks
Blood Supply
Venous Drainage
Lymphatic Drainage
Embryology
LYMPH NODES OF NECK
Physiology
Thyroid Swelling
HISTORY
AIM
O/E: EXAMINATION
Ophthalmoplegia
Chemosis
Optic Neuritis
CVS
Palpation
Berry's Sign
Auscultation
Lymph Nodes
Causes of Rapid Enlargement of Thyroid Gland
Mild Exophthalmos
Moderate Exophthalmos
Severe Exophthalmos
Malignant or Progressive Exophthalmos
Differential Diagnosis
INVESTIGATIONS
INVESTIGATIONS
Treatment
Myxoedema
Goitre
Postoperative Complications
Follicular Carcinoma
Anaplastic Carcinoma
Medullary Carcinoma
Types of Operations on Thyroid
4:
Neck Swellings
HISTORY
Examination
Inspection
Palpation
INVESTIGATIONS
Clinical Approach
Differential Diagnosis
TREATMENT
5:
Carcinoma Breast
ANATOMY
Arterial Supply
Venous Drainage
Lymphatic Drainage
Risk Factors
WHO Classification
History
Past History
Local Examination
Inspection
Palpation
Lump
Lymph Nodes
Lymph node Examination
General Examination
Differential Diagnosis
Traumatic Fat Necrosis
3. Mammography
Indications
Mammographic Picture
On Biopsy
4. Ultrasonography Indications
Investigations
Indications
TNM Staging System (New Classification)
State Grouping
Manchester's Classification
Management
Aim of Treatment
Modalities of Treatment
Surgery for Operable Breast Cancer
Role of Axillary Surgery
Treatment of Locally Inoperable Carcinoma of Breast
Therefore Systemic Therapy is Given
Radiotherapy
Indications
Complications
Chemotherapy
Response to chemotherapy after 3 cycles
Types of Chemotherapy
Gonadonan's regime
Hormone Therapy
Stage-wise Therapy
Locally Advanced Breast Cancer (LABC)
Management of Metastasis Breast Cancer (Stage III)
6:
Lymphoma
B CELLS
T CELLS
CLASSIFICATION OF NHL
Rappaoport's Classification
Duke-Collin's Classification
Working Formulation
REAL Classification
Aetiology
Clinical Presentation
HODGKIN'S DISEASE
Rye's Classification
Clinical Feature
HISTORY
History of Patient
History for Abdominal Lump
In Cervical LN
Examination
Local
Drainage Area
Abdomen
Cyst Examination
Differential
Cervical LN
Generalised LN
INVESTIGATIONS
General Work Up
For Disease
For Abdo. Lymphomas
For Staging of Disease
Cervical Characters of Lymphoma
INVESTIGATION IN HD
Staging Laparotomy (controversy)
Advantages
Disadvantages
Staging of HD (also used for NHL)Ann Aaber (a village in Michigan)
RX (TREATMENT)
NHL
Low Grade Lymphomas
Intermediate Grade
High Grade
Tumour Lysis Syndrome—Emergency
HD
RT
7:
Abdominal Lump
ANATOMY
SWELLINGS IN RIGHT HYPOCHONDRIUM
1. Liver
General properties of all liver swellings are:
Investigations
2. Gallbladder
Investigations
3. Subphrenic Abscess
4. Pylorus of Stomach/Duodenum
5. Hepatic Flexure of Colon
6. Kidney
Swellings
Bilateral
7. Suprarenal Gland
Investigations
1. Small Intestine and Mesentery
2. Cysts of mesentery
a. Appendix
b. Ileocaecal Region
c. Crohn's Disease
d. Carcinoma Caecum
e.
f.
D/Δ Renal Mass (Surgical Causes)
8:
Obstructive Jaundice
ANATOMY
Liver
Functions
Features
Peritoneal Relations/Ligaments
Lymphatic Drainage
Nerves Supply
Internal Anatomy
Sites of Porto Caval Shunts
Embryology
Endothelium
Extrahepatic biliary App.
Arterial Supply
Venous Drainage
Lymphatics
Bilirubin Metabolism
Jaundice
History and Ex
Examination
GPE
Signs of LCF
Curvoisier's Law
NVESTIGATION
ENNDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY (ERCP)
PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)
Indication for Exploring CBD
Ca Pancreas
9:
Burst Abdomen and Incisional Hernia
BURST ABDOMEN
Aetiology (6Ss)
∆
Treatment
Incisional Hernia
Aetiology
Clinical Feature: ∆stic
Treatment
Anatomical Repair
10:
Metastases in Liver
GPE
O/e
Causes of Bulky 2°
Type of 2°
Treatment
Hepatoma
Secondaries
Hydatid Cyst
11:
D/∆ of Gastric Outlet Obstruction
12:
Stomas
13:
Hernia
DEFINITION
ANATOMY-INGUINAL CANAL
Deep Inguinal Ring
Superficial Inguinal Ring
Boundaries
Structures Passing through Canal
Spermatc Cord
Mechanisms Preventing Hernia
External Abdominal Hernia
Precipitating Factors
Surgical Pathology
HISTORY AND EXAMINATION
History
Systemic Symptoms
Examination
Local Examination
Inspection
Palpation
Differential Diagnosis
Treatment
Conservative
Operative
I Herniotomy
II Herniorraphy
III Hernioplasty
Complication of Operations
Complications of Hernia
14:
Benign Hyperplasia Prostate
15:
Varicose Veins
DEFINITION
Anatomy
Tributaries
Short Saphenous Vein
Position
Perforators
Surgical Physiology
Blood return to heart
Aetiology
Causes
Secondary causes
History of Secondary Causes
Past H/o
Personal H/o
Family H/o
Examination
Local examination
History
Symptoms
Palpation
Site of Incompetence
Schwartz Test
Homan's sign
Moses sign
Site of Perforators
Fegan's test
Percussion
Auscultation
Complications
Investigations
Venography
Injection Sclerotherapy: Indications
Principle
Site of Injection
Complications of sclerotherapy
Operations
C/I FOR SURGERY
16:
Peripheral Vascular Disease
PULSATIONS
Investigations
Other Functions of Doppler
Management
Surgery
In Intermittent Claudication
Mechanism of Sympathectomy
Structures which may cause confusion
Failure of lumbar sympathectomy
Complications
Amputation
Indications
Distal Amputation
Major Amputations
Postoperative Case in Amputation
Arterial Surgeries
Treatment of Emboli
17:
Scrotal Swellings
LOCAL EXAMINATION
Inspection
Scrotal Skin
Fournier's Gangrene
Swelling
Cough Impulse
Palpation
Swelling
Fluctuation test
Cough Impulse
Examination of Testis
Position
Testicular Sensation
Epididymis
Spermatic Cord
Lymph Nodes
General Examination
Investigations
Intravenous Pyelography
Aschheim–Zondek test
Prostatic Massage
Differential Diagnosis
Primary Hydrocele
History
Symptoms
Examination
Testis
Skin Over the Swelling
Lymph Drainage
Spermatoceles Epididymal Cysts
Varicocele
Torsion of the Testis
Acute Epididymo-orchitis
Raising Test
Testicular Tumours
Tumours with more than one pattern
Stromal Tumours
Seminoma
Spread
Teratoma
Clinical Features of Testicular Tumours
Due to Lymphatic Spread
Staging
Management
Chevasu's procedure
Teratoma
Seminoma
Plan for the Diagnosis of Scrotal Swellings
18:
Leg Ulcers
ULCER
Pathological Classification
History
Examination
Inspection
Palpation
General Examination
DIFFERENTIAL DIAGNOSIS
1. Diabetic Foot
Sequence of events
Investigations
Management
2. Marjolin' Ulcer
3. Rare Ulcers
4. Malignant Melanoma
Aetiology
Classification
Clinical Picture
On Examination
Staging
Metastasis
5. Squamous Cell Carcinoma
Origin
Aetiology
Types
Lesion
Histology
Spread
19:
Examination of a Swelling
CAUSES OF SWELLING
HISTORY
PHYSICAL EXAMINATION
General Examination
Local Examination
Inspection
Palpation
Investigation
DIFFERENTIAL DIAGNOSIS
20:
Radiology and Minor OT Procedures
RADIOLOGY
A. PERFORATION
Management of Ulcer Perforation
B. OBSTRUCTION (MULTIPLE GAS AND FLUID LEVELS)
Management
Diagnosis of Strangulation
Other Corrections Correct Cause
STONES
RENAL STONE
Types
Treatment
Indication
C/I
Interpretation
BARIUM ENEMA
BARIUM MEAL FOLLOW THROUGH
ERCP (ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY)
MINOR OT
A. INCISION AND DRAINAGE
B. BREAST ABSCESS
C. HYDROCELE
D. SUPRAPUBIC CYSTOTOMY
a. Percutaneous
Indication
b. Open Method
Incision
E. CHOLECYSTECTOMY
F. CHEST TUBE
G. SEBACEOUS CYST
H. AVULSION OF CYST → ON SCALP
I. VENOUS CUT DOWN
J. LN BIOPSY
K. LIPOMA EXCISION
L. CLOSURE OF ABDOMINAL WALL
INDEX
TOC
Index
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