IOC & TOC in Systemic surgery
Head & neck , Lower GIT, Urogenital, Neurosurgery, Cardiac &
Vascular surgery, Breast , Thoracic surgery, ORTHOPEDIC,
THYROID UPPER GIT.
Reference : marow lecture & book
*IOC + TOC & PEARLS IN SYSTEMiC SURGERY*
*HEAD & NECK*
*RANULA*
Is due to
*EXTRAVASATION* not retention , Bluish swelling
Diagnosis Clinical + FNAC 🪡
TOC *Excision* of Ranula with sublingual gland
I/D avoided>>lead to Recurrence
*Parotid abcess*
Diagnosis clinical+ *USG*
TOC I/D through Hilton’s method
*SIALOLITHIASIS*
IOC Clinical+ Non-contrast CT *NCCT* (80./. Are radiopaque)
TOC *endoscopic* removal 1st choice
Radiolucent+ Non palpable than ESWL
Excision of gland *last choice*
*Pleomorphic adenoma*
, IOC *FNAC* 🪡 with USG
TOC *Parotidectomy* usually superficial
*MUCOEPIDERMOID CANCER*
IOC FNAC with USG
TOC low grade >> Parotidectomy
*High grade* + infiltrative >>> Sx+ *Radiotherapy*
*Carotid* body tumor/ Chemodectoma
IOC MR angiography (never do biopsy)
TOC careful surgery if symptomatic
*CYSTIC HYGROMA*
IOC clinical (transillumination+ fluctant) + Doppler USG
TOC *surgical excision* if very large *seclerotherapy* injection before surgery
*Branchial CYST*
Clinical diagnosis (fluctant swelling on ant border of sternocleidomastoid)
Management (can do FNAC) than *Surgical excision*
*ORAL CANCER*
Confirmation by
*Wedge* /edge incional *biopsy*
Imagingvof choice MRI
TOC
▫️ Surgery Wide Local *excision* (0.5cm wide margins) ±
▫️ Mandibular Resection ±
▫️ Neck dissection ±
▫️ Reconstitution by Flaps
, Adjuvent Therapy with chemo or Radio (IF EXTRAnodal disease+ lymphovascular
invasion + perineural invasion)
*Dermiod cyst* (skin pinchable) / *SABACEOUS* cyst (non pinchable skin)
Clinical diagnosis
Do CT & X-Ray if on head to check intracranial *Extension*
SURGICAL *EXCISION*
*LOWER GIT*
*INTESTINAL perforation*
Intial Investigation of *choice*
X-Ray chest & abdomen *Errect* /upright
Blood culture can be done (Typhoid)
Diagnostic Laparoscopy & biopsy is Gold standard in case Of TB
CT scan is Gold standard in Intestinal perforation
*Treatment* intial Resuscitation than *Laparotomy*
GIVE ATT in case of TB
& Ciprofloxacin in Typhoid too
*HIRSCHBURG DISEASE*
IOC Rectal *biopsy*
Also can do Barrium enema
TOC *Surgery* is definitive (duhmel , Swenson procedures)
*Ulcerative Colitis*
IOC Colonoscopy with Biopsy
Management
, Medical: 5ASA & steriod
*Surgery* TOTAL protocolectomy with *illeoanal* Anastomosis
*Fulminant* attack
Admit, NPO, iv fluids, antibiotics, analgesic, steroids , infliximab >>> no effect do
*surgery*
*CROHN’S DISEASE*
Diagnosis Colonoscopic biopsy
Toc Medical management through 5ASA, steriod, infliximab, immunosuppresive
agent
*No* Definitive surgery >> high Recurrnce after surgery
*Conservative surgery* is done when medical fails or complications occur
*Intussusception*
IOC in children *USG* abdomen (Target sign ,bull eye ) kidney shaped mass in RIF
*Barium enema* Gold standard used as *diagnostic (claw sign) & Therapeutic*
purpouse too
TOC start conservative, Hydrostatic pushed by enema,
*Surgery* if above fails (Resection & anastomosis)
*Sigmiod volvulus*
IOC CECT
X-Ray shows coffe bean 🪡 sign
Toc *Sigmoidoscopic Decompression* surgery (sigmidectomy)
If *peritonitis* develop do *Laparotomy* than do *heartman procedure* if perforation is
present
*Intestinal Strictures*
Intial IOC x-Ray errect & supine
TOC Resection & anastomosis (if strictures are close)
Head & neck , Lower GIT, Urogenital, Neurosurgery, Cardiac &
Vascular surgery, Breast , Thoracic surgery, ORTHOPEDIC,
THYROID UPPER GIT.
Reference : marow lecture & book
*IOC + TOC & PEARLS IN SYSTEMiC SURGERY*
*HEAD & NECK*
*RANULA*
Is due to
*EXTRAVASATION* not retention , Bluish swelling
Diagnosis Clinical + FNAC 🪡
TOC *Excision* of Ranula with sublingual gland
I/D avoided>>lead to Recurrence
*Parotid abcess*
Diagnosis clinical+ *USG*
TOC I/D through Hilton’s method
*SIALOLITHIASIS*
IOC Clinical+ Non-contrast CT *NCCT* (80./. Are radiopaque)
TOC *endoscopic* removal 1st choice
Radiolucent+ Non palpable than ESWL
Excision of gland *last choice*
*Pleomorphic adenoma*
, IOC *FNAC* 🪡 with USG
TOC *Parotidectomy* usually superficial
*MUCOEPIDERMOID CANCER*
IOC FNAC with USG
TOC low grade >> Parotidectomy
*High grade* + infiltrative >>> Sx+ *Radiotherapy*
*Carotid* body tumor/ Chemodectoma
IOC MR angiography (never do biopsy)
TOC careful surgery if symptomatic
*CYSTIC HYGROMA*
IOC clinical (transillumination+ fluctant) + Doppler USG
TOC *surgical excision* if very large *seclerotherapy* injection before surgery
*Branchial CYST*
Clinical diagnosis (fluctant swelling on ant border of sternocleidomastoid)
Management (can do FNAC) than *Surgical excision*
*ORAL CANCER*
Confirmation by
*Wedge* /edge incional *biopsy*
Imagingvof choice MRI
TOC
▫️ Surgery Wide Local *excision* (0.5cm wide margins) ±
▫️ Mandibular Resection ±
▫️ Neck dissection ±
▫️ Reconstitution by Flaps
, Adjuvent Therapy with chemo or Radio (IF EXTRAnodal disease+ lymphovascular
invasion + perineural invasion)
*Dermiod cyst* (skin pinchable) / *SABACEOUS* cyst (non pinchable skin)
Clinical diagnosis
Do CT & X-Ray if on head to check intracranial *Extension*
SURGICAL *EXCISION*
*LOWER GIT*
*INTESTINAL perforation*
Intial Investigation of *choice*
X-Ray chest & abdomen *Errect* /upright
Blood culture can be done (Typhoid)
Diagnostic Laparoscopy & biopsy is Gold standard in case Of TB
CT scan is Gold standard in Intestinal perforation
*Treatment* intial Resuscitation than *Laparotomy*
GIVE ATT in case of TB
& Ciprofloxacin in Typhoid too
*HIRSCHBURG DISEASE*
IOC Rectal *biopsy*
Also can do Barrium enema
TOC *Surgery* is definitive (duhmel , Swenson procedures)
*Ulcerative Colitis*
IOC Colonoscopy with Biopsy
Management
, Medical: 5ASA & steriod
*Surgery* TOTAL protocolectomy with *illeoanal* Anastomosis
*Fulminant* attack
Admit, NPO, iv fluids, antibiotics, analgesic, steroids , infliximab >>> no effect do
*surgery*
*CROHN’S DISEASE*
Diagnosis Colonoscopic biopsy
Toc Medical management through 5ASA, steriod, infliximab, immunosuppresive
agent
*No* Definitive surgery >> high Recurrnce after surgery
*Conservative surgery* is done when medical fails or complications occur
*Intussusception*
IOC in children *USG* abdomen (Target sign ,bull eye ) kidney shaped mass in RIF
*Barium enema* Gold standard used as *diagnostic (claw sign) & Therapeutic*
purpouse too
TOC start conservative, Hydrostatic pushed by enema,
*Surgery* if above fails (Resection & anastomosis)
*Sigmiod volvulus*
IOC CECT
X-Ray shows coffe bean 🪡 sign
Toc *Sigmoidoscopic Decompression* surgery (sigmidectomy)
If *peritonitis* develop do *Laparotomy* than do *heartman procedure* if perforation is
present
*Intestinal Strictures*
Intial IOC x-Ray errect & supine
TOC Resection & anastomosis (if strictures are close)
