Fibro Adenoma Breast

What is Fibro Adenoma?

Definition:- Fibro Adenoma is the Benign Hyperplasia of a Single Lobule of Breast.

Fibro Adenoma is also called 'Breast Mouse' as it is very mobile inside the breast tissue.

Usual Age group of Fibro Adenoma : 15-25 yrs

What is the Treatment of Fibro Adenoma?

Surgical Excision  through a Cosmetically Acceptable Incision.

What are the types of Incisions on Breast for Benign Breast Diseases?

Circum Areolar and Radial.

Advantage of Circum Areolar Incision- Better Cosmesis

Disadvantage of Circum Areolar Incision- More Injury to Lactiferous Ducts.

Advantage of Radial  Incision- Less Injury to Lactiferous Ducts.

Disadvantage of Radial Incision- Cosmetically less appealing

What is Giant Fibro Adenoma?

Fibro Adenoma of size more than 5cm is called a Giant Fibro Adenoma.

What is the Risk of Malignancy in Fibro Adenoma?

Very less. (1 in 1000 only)

Carcinoid Tumor of Appendix

Carcinoid Tumor of  Appendix

The word Carcinoid means ‘carcinoma like appearance’.

 In the the small bowel Carcinoid tumors arise from Kulchistsky cells located in the crypts of Lieberkuhn.

Kulchistsky cells are also called Argetaffin cells as these cells can be stained by the silver compounds.

Usual age group of Carcinoid Tumor  : Fifth/Sixth Decade of Life

The Most Common Siteof Carcinoid Tumor  : Appendix

Vermiform Appendix

Other Sites of G I Carcinoid Tumor  : Small Intestine, Rectum, Colon, Stomach

Non Intestinal sites of Carcinoid Tumor  : Lungs, Pancreas, Thymus, Ovary, Testis, Biliary tract

Embryologic Classification of Carcinoids

1.     Foregut Carcinoids-Lungs, Stomach & Pancreas

2.     Midgut Carcinoids-Small Intestine & Appendix

3.     Hindgut Carcinoids-Colon & Rectum

Carcinoid Syndrome

• Seen in 10% of cases of
• Due to release of ,Serotonin, Histamine, Bradykinin, Prostaglandin
• Clinical features : Flushing, Watery Diarrhea, Sweating, Wheezing, Breathlessness, Abdominal pain and Hypotension.

Investigations

Urinary 5-HIAA, Chromogranin A

CT Scan Abdomen

CT Scan Chest-for Bronchial Carcinoids

Treatment of Carcinoid Tumor Appendix

If the Carcinoid Tumor Appendix is less than 2 cm and is away from the base, the treatment is Appendicectomy.

Open Appendicectomy

If the Carcinoid Tumor Appendix is close to the base of the appendix or the size is more than 2cm the treatment is Right Hemi Colectomy.

What is Carcinoid Crisis?

Life threatening form of Carcinoid syndrome.

Usually precipitated by Anesthesia, Surgery, Chemotherapy

Prophylactic agent used prevent Carcinoid crisis is Octreotide ( Somatostatin Analogue)

 

Colonic Pseudo Obstruction/ Ogilvie Syndrome

Colonic Pseudo Obstruction/ Ogilvie Syndrome

Plain Abdominal Radiograph-Ogilvie Syndrome

CT Scanogram-Colonic Pseudo Obstruction

Obstruction of Colon without any mechanical cause is termed as Ogilvie Syndrome or Colonic Pseudo Obstruction.

Patient can present with features of Intestinal Obstruction namely

• Abdominal Distension
• Constipation
• Colicky Abdominal Pain
• Vomiting

10 Common causes of Colonic Pseudo Obstruction/ Ogilvie Syndrome

1.      Hypokalaemia

2.      Uremia

3.      Septicemia

4.      Burns

5.      Trauma

6.      Myocardial Infarction

7.      Diabetes mellitus

8.      Tricyclic Anti Depressants ( Drugs )

9.      Pancreatitis

10.Idiopathic

 

Depressed Fracture Skull

Depressed Fracture Skull

CT Scan Head -Depressed Fracture Right Frontal Bone

CT Scan Head -Depressed Fracture Right Frontal Bone

Depressed Fracture Skull can damage brain parenchyma and can result in Pressure effect or Midline shift.

Indications of Surgical Elevation of a Depressed Fracture Skull are

1.     Paediatric patients

2.     Seizures

3.     Depression more than 1.5cm in to the brain parenchyma.

In other cases conservative line of management with Neurosurgery observation ( Head Injury Chart ) may be sufficient.

Head Injury Chart Includes Hourly Monitoring of

1.     Pulse Rate

2.     Blood Pressure

3.     GCS

4.     Pupils- Size and Reaction to Light

5.     Respiratory Rate

6.     Body Temperature

7.     Power of Upper Limbs

8.     Power of Lower Limbs

 

Necrotizing Fasciitis/ Fournier’s Gangrene

Necrotizing Fasciitis/ Fournier’s Gangrene

Fournier’s Gangrene is Necrotizing Fasciitis affecting the perineum.

 It is a rapidly spreading poly microbial infection caused mainly by Gram Positive Cocci and Gram Negative Bacilli (  Both Aerobes and Anerobes). Hence called Synergistic Gangrene.

The skin over the affected area becomes gangrenous because of the thrombosis of underlying small blood vessels.

Extensive tissue necrosis occurs between the tissue planes resulting in Inflammatory Degloving, Septicemia and Renal failure.

Diagnosis can be made by clinical grounds and can be confirmed by biopsy of the necrosed tissue.

The enzyme elevated in Necrotizing Fasciitis is Creatinine kinase.

Treatment-

• Radical Surgical Debridement to remove the devitalized tissues.
• Antibiotics ( Penicillin, Third generation Cephalospoirns and Metronidazole).
• Hyperbaric Oxygen Therapy.

 

Pyogenic Granuloma

 Pyogenic Granuloma Scalp



Pyogenic Granuloma Scalp



Pyogenic Granuloma is a superficial polypoid mass formed of Granulation Tissue. It is formed as a result of chronic infection. Often associated with pain. Dull Red in color.

Clinical Features :Can occur anywhere in the body. Common sites are Face, Fingers, Toes etc

Complications:- Bleeding, Infection.

Treatment:- Surgical Excision



Intestinal Obstruction

Intestinal Obstruction

Multiple Air Fluid Levels

Intestinal Adhesion

Intestinal Adhesion

Intestinal Adhesion

The most Common Extra Mural Cause of Intestinal Obstruction is Intestinal Bands or Adhesions.

The Intestinal Bands or Adhesions can be Congenital or Acquired.

Previous surgery in the abdomen can later result in adhesions between the loops of the intestine.

Clinical Features of Intestinal Obstruction

• Constipation
• Vomiting
• Colicky Abdominal Pain
• Visible Peristalsis
• Abdominal Distension

In the plain radiograph the dilated bowel loops becomes visible.

Multiple Air Fluid Levels are seen.

Basis of Visible Intestinal Loops in a Plain Radiograph in Intestinal Obstruction

Normally Intestinal loops are not visible in a plain radiograph. This is because the intestine are in a state of constant peristaltic movement and there is no tissue oedema. When there is obstruction the peristalsis is abolished and the mucosa of the intestine becomes oedematous. Due to these two reasons the intestinal loops becomes visible in a plain radiograph.

The basis of Air fluid levels in Intestinal Occlusion

Normally Air and Food inside the intestine are in a mixed form. But when the obstruction occurs due to stagnation of the content separation of the Air and Fluid occurs.

How many Air Fluid levels are clinically significant?

Normally Air Fluid Levels are seen at sites inside the Abdomen. One  in the Fundus of the stomach, another in the First part of Duodenum and the third in the Ileo Caecal Region. Hence more than three Air Fluid Levels are considered as abnormal.