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Top100 Diseases

 surgical problems

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Acute abdomen
Acute abdomen is most commonly a surgical presentation, rather than being a disease in itself. It is important to have a clear approach to the assessment and management of this condition.

What to learn
  • The differential diagnosis of an acute abdomen.
  • Symptoms and signs of peritonitis.
  • The diagnostic approach and investigations required.
  • Initial management.

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Appendicitis is a common surgical problem that can present at any age but with a peak incidence in the teen years and early adulthood. Diagnosis can be problematic because classic symptoms occur in only 55% of cases.

What to learn
  • Etiology of appendicitis, and vulnerable groups.
  • Symptoms, signs, and differential diagnosis of appendicitis.
  • Clinical course of the disease.
  • Management of acute appendicitis.

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Diverticular disease
This is a very common condition in the West and is caused by lack of dietary fiber. It affects two-thirds of the population by the age of 70 years and is more common in women than men (3:2). Many cases are asymptomatic, and the most common symptom on presentation is abdominal pain.

What to learn
  • Etiology and risk factors for diverticular disease.
  • Definitions of diverticular disease: diverticulosis, diverticulitis.
  • Symptoms, signs and differential diagnosis.
  • Clinical features and complications.
  • Conservative and surgical management.

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This occurs in 10 to 20 per 100,000 people per year in the UK. Most cases of acute pancreatitis are caused by gallstones or alcohol. Pancreatitis is a potentially life-threatening condition with an overall mortality of 8% to 10%.

What to learn
  • Etiology and risk factors for pancreatitis.
  • Symptoms, signs, and diagnostic tests.
  • Ranson's criteria for assessment of severity, and clinical course of the disease.
  • Management of acute pancreatitis.

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Large bowel obstruction
This is a common cause of an acute abdomen and is characterized by the symptoms and signs of abdominal pain, distension, vomiting, and inability to pass stool or flatus. Common causes include simple constipation, cancer of the colon, diverticular stricture, and sigmoid volvulus.

What to learn
  • Symptoms, signs, and differential diagnosis of large bowel obstruction.
  • Diagnostic investigations.
  • Conservative and surgical management.

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Gallstones are very common, but only a small minority of adults with gallstones develop acute cholecystitis, which in 95% of cases is due to the impaction of a gallstone in Hartmann's pouch.

What to learn
  • Aetiology and risk factors for gallstones - the F's (Fat, Fertile Females).
  • Symptoms and signs of acute cholecystitis.
  • Clinical course and diagnosis of acute and chronic cholecystitis.
  • Conservative, endoscopic and surgical management.

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A hernia is the abnormal protrusion of a viscus, or of part of a viscus, through the coverings that contain it. Incisional hernias are the most common type, followed by inguinal, femoral, and finally, umbilical hernias. Inguinal hernia occurs in 1% to 2% of children, mostly boys (9:1), and in 112 per 100,000 adults per year in the UK. The ratio of inguinal to femoral hernias is 40:1 in men and 3:1 in women.

What to learn
  • The anatomy of the inguinal and femoral canals, and etiology of hernias.
  • Classification of hernias by location, type, and severity.
  • Symptoms, signs, and differential diagnosis for the above types of hernia.
  • Conservative and surgical management.
  • Refresh your knowledge of the regional anatomy.
  • Risk factors for testicular torsion.
  • Surgical management.

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Testicular torsion
Testicular torsion is an acute and painful condition caused by rotation of a testis on its mesentery, so that blood supply is impaired, resulting in ischemic pain and edema. It is a surgical emergency, and the torsion must be corrected within hours to save the testis. It occurs at any age but most often during adolescence.

What to learn
  • Etiology and risk factors for testicular torsion.
  • Symptoms, signs, and classification of testicular torsion.
  • Surgical management, and prognosis.

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Hemorrhoids constitute a common problem caused by hypertrophy of vascular cushions of tissue at the anal margin. It is a condition of mid-to-late adulthood; half of all patients are over the age of 50. Symptoms are rectal bleeding, prolapse, pain, mucous discharge, and prutitus ani.

What to learn
  • Symptoms, signs, and classification of hemorrhoids.
  • Conservative and surgical management, and prognosis.
  • Etiology and risk factors for hemorrhoids.

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