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 instrument that works via guiding the reader via scientific situations, imitating those who scholars and junior medical professionals are inclined to meet in coincidence and emergency and outpatient departments, and commonly perform.
100 circumstances in Surgery offers a hundred surgical eventualities more often than not visible and taken care of via clinical scholars and junior medical professionals. The patient's historical past, exam and preliminary research effects are offered along questions about the analysis and administration of every case. the reply incorporates a targeted dialogue on every one subject supplying a necessary revision relief for college students and junior doctors.
Making scientific judgements is likely one of the such a lot tough and tough elements of teaching to turn into a physician. those circumstances will educate scholars and junior medical professionals to understand very important surgical stipulations and aid them improve their diagnostic and administration skills.
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Diverticular disease is very common, with over 60 per cent of the population affected by the age of 80 years. It is more common in developed countries due to low-fibre diets. The low-bulk stool leads to increased segmentation of the colon during propulsion, causing increased intraluminal pressure and formation of diverticula. They are found most commonly in the sigmoid colon (95–98 per cent of diverticula), but any part of the bowel may be affected. The majority of patients with diverticula remain symptomless.
7 mmol/L 44–80 μmol/L 0–100 IU/dL 5–35 IU/L 35–110 IU/L 11–51 IU/L 35–50 g/L 3–17 mmol/L 1–13 mm/h Questions • • • • What differential diagnoses would you consider? The biopsy suggests ulcerative colitis. What are the typical histological findings? 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.
Patients should be managed aggressively and may require treatment in a highdependency or in intensive care unit. 47 This page intentionally left blank Upper Gastrointestinal CASE 23: fever, pain and jaundice History As the junior doctor on call, you are asked to review the blood results of an 87-year-old man who was admitted that morning with possible appendicitis. He is confused and unable to give an accurate history. He had been spiking temperatures during the afternoon and had increasing right-sided abdominal pain.