2. RIGHT ILLIAC FOSSA
•
Abdomen is divided into
9 regions
2 Horizontal planes:
Upper/Transpyloric
Lower/Transtubercular
2 Vertical planes:
one on either side
through the midpoint
between ASIS &
symphysis pubis.
9. APPENDICULAR MASS
complication of acute appendicitis.
Mass consists of greater omentum with oedematous caecal wall
& loops of distal small intestine with inflammed appendix in
centre,
natural phenomenon to contain spread of infection
Firm , tender, irregular mass in RIF ,with localised guarding &
rigidity & systemic manifestations
USG and CECT –helpful in assessing the nature & size of mass
10. 1.Conservative(Ocshner-Sherren regimen)
pulse and temperature monitoring
Monitoring the size of mass
I.V Fluids & I.V Antibiotics
Interval-Appendicectomy after 6 weeks
2.Emergency Surgery
Rising pulse rate & temperature
persistant vomiting
Increasing abdominal pain
Increase in size of the mass,
11. APPENDICULAR ABSCESS
Complication of acute appendicitis
Pt. is toxic ,with high grade fever & tachycardia.
tender mass with indistinct borders , guarding &
rigidity
USG/CT for size of abscess
Treatement
conservative( < 4 cms)
USG guided aspiration( > 4 cms )
surgical drainage ( failure of other modes )
Interval appendicectomy after 12 weeks
12. Neoplasms of the appendix
Carcinoid tumour (argentaffinoma)
arise from Kulchitsky cells of the crypts of Lieberkühn
vermiform appendix is the most common site
most common neoplasm of the vermiform appendix
it’s commonly a incidental finding / painless well defined
firm to hard mass
carcinoid syndrome(flushing & diorrhoea) in liver
metastases
13. Investigations
24 hrs urine 5HIAA,
sr.chromogranin A ,
USG ,
CECT ,
SOMATOSTATIN RECEPTOR SCINTIGRAPHY
Treatment
< 1 cm – appendicectomy
>1 cm – right hemicolectomy
metastases – metastasectomy
21. CROHN`S DISEASE
Can involve any part of GIT . ileocoloic region most common site
skip lesions
(cobblestone appearance) Mucosal ulceration with oedema of
mucosa between the ulcers
Transmural inflammation leading to adhesions & inflammatory
masses formation with mesenteric abscess & fistula formation into
adjacent organs.
Serosa is opaque,with mesenteric thickening &enlarged mesenteric
lymph nodes.
CECT , Barium meal follow through , colonoscopy & biopsy
uncomplicated - steroids , anti-inflammatory, immunosupressants
Complicated – resection & ostomy/ reconstruction
24. CARCINOMACAECUM
3rd common site for colonic carcinoma
unexplained anemia is the common presentation
Altered bowel habits , obstruction , perfotation
hard, nontender, fixed mass
25. • Aetiology ;
• 1. DIET -Red meat, saturated fat and cholesterol
• 2.Alcohol and smoking
• 3.Radiation
• 4. Post-cholecystectomy and ileal resection and
ureterocolostomy status
• 5.Genetic causes
Familial Adenomatous polyposis coli.
Gardner's syndrome and Turcot’s syndrome.
Peutz jeger’s syndrome and Juvenile polyposis syndrome.
HNPCC , Lynch syndrome1, Lynch syndrome 2
Aspirin and other NSAIDs, calcium are protective
against large bowel cancers
32. INTUSUSCEPTION
Cause:
Children : Hyperplasia of peyer’s patches
Adult : polyps, submucosal lipoma, tumour, prolonged fasting
Types: ileo-ileal , ileo-colic , Colocolic common in adults
Pathology
3 parts
Entering or inner tubes ( blood supply is commonly impaired)
Returning or middle part,
sheath or outer tube(Intessuscipiens)
33.
34. o acute / sub-acute
o colicky abdominal pain ,bilious vomiting , abdominal lump
freely mobile , becomes firm on palpation , intestinal
obstruction , guarding & rigidity ( gangrene )
o red current jelly stool
o emptiness on the RIF(sign de dance)
o investigations
AXR – absent caecal gas / multiple air-fluid levels
barium enema – claw sign
USG – psuedokidney sign/ bull’s eye sign
CECT
o treatment
hydrostatic reduction
resection and reconstruction
.
36. PSOAS ABSCESS
It’s a cold abscess due to Tuberculosis of Thoracolumbar spine
(Pott`s disease)
caseating pus from vertebra gravitates via medial arcuate ligament
underneath psoas sheath
psoas sign - Thigh is in fixed flexion position due to
psoas muscle spasm
Cross fluctuation – pus tracks below inguinal ligament
into thigh
Spinal tenderness/Gibbus can be demonstrated.
X-ray of spine ,CT , MRI
Treatment –Image guided aspiration / I & D
ATT
spinal support with bed rest
38. Aneurysm
• well defined fusiform pulsatile mass
• may present with distal ischemia
• USG ,duplex , Angiography
• stenting / resection & reconstruction
39. OTHER CAUSES
ROUND WORM BOLUS MASS
soft tender mass in RIF.
With H/O of passing round worms in Stools.
Most common in children in endemic areas,causing intestinal
obstruction.
TUMOURS OF ILIAC CREST
Osteochondroma,hard fixed bony swelling .
