By James Gossage, Bijan Modarai, Arun Sahai, Richard Worth
The purpose of the a hundred circumstances sequence is to supply a singular studying and revision device that works by way of guiding scholars via medical circumstances, imitating those who scholars and condominium officials are inclined to meet in coincidence and emergency and outpatient departments, and usually practice.The circumstances are written to curiosity scholars in scientific difficulties and to aid them increase their talents of medical reasoning, with every one situation supplying info of a patient's clinical historical past and the foremost findings of a medical exam, including preliminary research effects info for evaluation.Key questions then suggested scholars to judge the sufferer, and succeed in a call concerning the patient's and the prospective therapy plan; whereas the reply pages can help scholars to appreciate the techniques clinician or health care provider is going via in such events. Designed with the coed in brain, this quantity contains gains to help self-directed studying, medical pondering and problem-solving.100 instances in surgical procedure covers universal and more odd proceedings provided, within the following surgical area of expertise components: vascular, breast, endocrine, urology, orthopedic, neurosurgery, top GI, decrease GI, anesthesia, and put up operative problems.
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Extra resources for 100 Cases in Surgery (A Hodder Arnold Publication)
In the absence of metastatic disease, the patient should undergo right hemicolectomy. Adjuvant chemotherapy may be required, depending on the depth of the resected tumour and involvement of the local lymph nodes. If metastatic disease is present then a palliative resection should be considered in patients with anaemia or obstruction. KEY POINT • Serum ferritin should be checked in patients with microcytic anaemia. 24 General and colorectal CASE 13: ABDOMINAL DISTENSION AND PAIN History A 70-year-old man has been sent to the emergency department from a nursing home, complaining of intermittent sharp abdominal pain.
41 100 Cases in Surgery ANSWER 20 ! The main differential diagnoses for a patient with this history and symptoms • Inflammatory bowel disease: Crohn’s disease or ulcerative colitis • Infective diarrhoea: Shigella, Salmonella, Yersinia and Campylobacter • Pseudomembranous colitis: secondary to antibiotic use In view of the patient’s history, a biopsy of the rectal mucosa and stool sample should be sent. Microbiology can analyse the sample for an infective cause or test for Clostridium difficile toxin in cases of pseudomembranous colitis.
1 Plain X-ray of the abdomen. Questions • What does the abdominal X-ray show? • What other radiological investigation could be employed if the diagnosis was in doubt? • How should the patient be managed? • What is the explanation for the pathology? 25 100 Cases in Surgery ANSWER 13 The X-ray shows a sigmoid volvulus. The sigmoid colon is grossly dilated and has an inverted U-tube shape. The involved bowel wall is usually oedematous and can form a dense central white line on the radiograph. On either side, the dilated loops of apposed bowel give the characteristic ‘coffee bean’ sign.