By James Gossage, Bijan Modarai, Arun Sahai, Richard Worth
The purpose of the a hundred circumstances sequence is to supply a unique studying and revision device that works by way of guiding scholars via medical circumstances, imitating those who scholars and condo officials tend to meet in coincidence and emergency and outpatient departments, and generally practice.The instances are written to curiosity scholars in medical difficulties and to assist them strengthen their talents of scientific reasoning, with each one state of affairs supplying information of a patient's clinical historical past and the most important findings of a scientific exam, including preliminary research effects facts for evaluation.Key questions then advised scholars to judge the sufferer, and succeed in a choice concerning the patient's situation and the prospective remedy plan; whereas the reply pages can help scholars to appreciate the procedures clinician or healthcare professional is going via in such events. Designed with the coed in brain, this quantity contains gains to help self-directed studying, medical considering and problem-solving.100 instances in surgical procedure covers universal and more odd court cases provided, within the following surgical uniqueness parts: vascular, breast, endocrine, urology, orthopedic, neurosurgery, top GI, reduce GI, anesthesia, and put up operative problems.
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Extra info for 100 Cases in Surgery (A Hodder Arnold Publication)
What are the options for treatment? • Which are the worrying symptoms in the patient’s history? 21 100 Cases in Surgery ANSWER 11 A sessile mass is seen occupying approximately half of the bowel wall circumference. A biopsy of the lesion should be taken at the time of sigmoidoscopy to confirm the diagnosis of rectal cancer. g. carcinoembryonic antigen [CEA]) should be arranged. An urgent colonoscopy is required to determine whether there are any synchronous cancers (5 per cent) or synchronus polyps (75 per cent) in the rest of the large bowel.
The potential for malignant change is relatively high with long-standing ulcerative colitis and the risk in patients with pancolitis is approximately 3 per cent after 10 years. The risk of developing mucosal dysplasia increases with time, and surveillance should commence after 7 years. Colonoscopy and biopsy are performed every 2–3 years. If dysplasia is detected, the patient should undergo total colectomy with end ileostomy. KEY POINTS • Long-standing ulcerative colitis carries a ϳ3 per cent risk of malignant change after 10 years.
The barium enema demonstrates a stenosis at the rectosigmoid junction secondary to a tumour (arrow in Fig. 2). 2 Barium enema demonstrating a stricture at the rectosigmoid junction (arrow). 30 General and colorectal KEY POINTS Causes of large-bowel obstruction are: • • • • • carcinoma diverticulitis volvulus intussusception colonic pseudo-obstruction. 31 This page intentionally left blank General and colorectal CASE 16: LEFT ILIAC FOSSA PAIN History You are called to see a 66-year-old woman in the emergency department, who is complaining of a 5-day history of increasing left iliac fossa pain.
100 Cases in Surgery (A Hodder Arnold Publication) by James Gossage, Bijan Modarai, Arun Sahai, Richard Worth