Last
Postoperative management of this case must include
Postoperative management of this case must include
Anonymous Quiz
97%
PPI & H2 blocker
3%
Aspirin
70 y old man has dyspepsia & epigastric pain doesn’t response to medical treatment
On examination he has cachexia & upper abdominal mass . You suspect
On examination he has cachexia & upper abdominal mass . You suspect
Anonymous Quiz
99%
Cancer stomach
1%
Gastritis
Examination revealed malignant mass in the middle third of stomach with operability
Treatment is
Treatment is
Anonymous Quiz
95%
Radical Total gastrectomy
5%
Palliative gastrostomy
All of the following can cause cancer stomach except
Anonymous Quiz
4%
Chronic H pylori
19%
Achlorohydria
4%
Gastric polyp
72%
E coli infection
1%
Irritant diet
0%
Chronic gastric ulcer
DD epigastric mass includes All of the following except
Anonymous Quiz
3%
Cancer transverse colon
1%
Para aortic Lymph Node
2%
Pancreatic mass
92%
Cancer urinary bladder
1%
Aortic aneurysm
Middle aged female has a history of osteoarthritis & NSAID intake for long period
Suddenly she developed hematemesis
You suspect
Suddenly she developed hematemesis
You suspect
Anonymous Quiz
90%
Acute gastric erosion
10%
Stress ulcer
She feels worried about her condition
Tell her the truth
Tell her the truth
Anonymous Quiz
85%
She has a good prognosis
15%
She has a bad prognosis
📝📝📝
Golden rules for case answer
• diagnosis
Don’t forget Rt ot Lt
Complicated or not
Acute or chronic
Justify your diagnosis (positive data)
Mention DD if possible
If cancer mention the stage
Example
Right LL acute embolic ischemia complicated by gangrene
Positive data
History of cardiac disease , young patient, sudden severe ll pain , absent pulsation
DD
Thrombotic ischemia but occurs in old atherosclerotic
•investigations
If emergency avoid time consuming investigation (arteriography in acute is ischemia started 6 h ago)
If shocked resuscitate first then investigate
If arterial bleeding no investigation needed, exploratory surgery
-What is the diagnostic investigation & sign
-What is the contraindicated investigation ( endoscopy in case of perforated peptic ulcer , thyroid scan with radioactive iodine in pregnancy )
Investigate cause & predisposing factor (DM , Lipid profile ..)
Investigate general condition (CBC , electrolyte)
If patient need operation request pre operative routine investigation (ECG , lipid profile, BP , glucose level ...)
If cancer search for secondaries
• TTT
It’s emergency or not
If bleeding resuscitate
-pre operative preparation
(Aspiration of fluid in case of perforated peptic ulcer, propanol before thyroidectomy ...$
Type of anathesia
Need Drain ??
Mention structure you need to protect during surgery ( recurrent laryngeal in case of throidectomy)
- post operative care
Follow up for complication & effectiveness of treatment
Golden rules for case answer
• diagnosis
Don’t forget Rt ot Lt
Complicated or not
Acute or chronic
Justify your diagnosis (positive data)
Mention DD if possible
If cancer mention the stage
Example
Right LL acute embolic ischemia complicated by gangrene
Positive data
History of cardiac disease , young patient, sudden severe ll pain , absent pulsation
DD
Thrombotic ischemia but occurs in old atherosclerotic
•investigations
If emergency avoid time consuming investigation (arteriography in acute is ischemia started 6 h ago)
If shocked resuscitate first then investigate
If arterial bleeding no investigation needed, exploratory surgery
-What is the diagnostic investigation & sign
-What is the contraindicated investigation ( endoscopy in case of perforated peptic ulcer , thyroid scan with radioactive iodine in pregnancy )
Investigate cause & predisposing factor (DM , Lipid profile ..)
Investigate general condition (CBC , electrolyte)
If patient need operation request pre operative routine investigation (ECG , lipid profile, BP , glucose level ...)
If cancer search for secondaries
• TTT
It’s emergency or not
If bleeding resuscitate
-pre operative preparation
(Aspiration of fluid in case of perforated peptic ulcer, propanol before thyroidectomy ...$
Type of anathesia
Need Drain ??
Mention structure you need to protect during surgery ( recurrent laryngeal in case of throidectomy)
- post operative care
Follow up for complication & effectiveness of treatment
