By James Gossage, Bijan Modarai, Arun Sahai, Richard Worth
The purpose of the a hundred instances sequence is to supply a singular studying and revision software that works via guiding scholars via medical situations, imitating those who scholars and condo officials tend to meet in twist of fate and emergency and outpatient departments, and often practice.The circumstances are written to curiosity scholars in scientific difficulties and to aid them enhance their abilities of medical reasoning, with every one state of affairs supplying information of a patient's clinical heritage and the main findings of a medical exam, including preliminary research effects facts for evaluation.Key questions then urged scholars to judge the sufferer, and achieve a choice concerning the patient's situation and the potential therapy plan; whereas the reply pages can help scholars to appreciate the methods clinician or health care professional is going via in such occasions. Designed with the coed in brain, this quantity contains beneficial properties to help self-directed studying, scientific considering and problem-solving.100 instances in surgical procedure covers universal and more odd court cases awarded, within the following surgical uniqueness parts: vascular, breast, endocrine, urology, orthopedic, neurosurgery, top GI, decrease GI, anesthesia, and publish operative issues.
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Additional info for 100 Cases in Surgery (A Hodder Arnold Publication)
How should the patient be managed acutely? • What is the potential for malignant change associated with this condition? 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.
Decompression of the large bowel with a loop colostomy is the safest procedure to perform in the first instance. Some centres are now using colonic stents to relieve obstruction, but these are not available at all institutions. More definitive surgery can then be planned after optimization and further imaging. A contrast enema can be used to determine the level of the obstruction and if it is complete. If the patient is stable and is suspected of having a tumour, then a staging computerized tomography should be done.
The patient’s fitness for surgery, prognosis and quality of life should be considered before proceeding to laparotomy. It may be appropriate to use only conservative treatments in some patients. Sigmoid volvulus is predisposed to by a long, narrow mesocolon, chronic constipation or a high-roughage diet. The rotation of the gut can lead to obstruction and intestinal ischaemia. The sigmoid is the commonest part of the colon for this to occur, although the caecum and splenic flexure are other potential sites.
100 Cases in Surgery (A Hodder Arnold Publication) by James Gossage, Bijan Modarai, Arun Sahai, Richard Worth