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SURGICAL DISEASES DIAGNOSIS

SURGICAL DISEASES DIAGNOSIS. HYSTORY CLINICAL EXAMINATION LAB.TESTS IMAGISTIC INVESTIGATIONS. TREATMENT MODALITIES. SURGERY - CLASIC OR MINIMALLY INVASIVE (LAPAROSCOPIC)

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SURGICAL DISEASES DIAGNOSIS

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  1. SURGICAL DISEASESDIAGNOSIS HYSTORY CLINICAL EXAMINATION LAB.TESTS IMAGISTIC INVESTIGATIONS

  2. TREATMENT MODALITIES • SURGERY - CLASIC OR MINIMALLY INVASIVE (LAPAROSCOPIC) • MEDICAL- COMORBIDITIES, DEFFICITS CORRECTION: SEVERE ANEMIA HYPOVOLEMIA, DISELECTROLYTEMIA, ANTIBIOTICS, ANTICOAGULANTS • ADJUVANT, NEOADJUVANT: RADIOTHERAPY, CHEMOTHERAPY

  3. SURGICAL TREATMENT • THE RIGHT OPERATION PERFORMED WELL • THE RIGHT OPERATION PERFORMED BADLY • THE WRONG OPERATION PERFORMED WELL • THE WRONG OPERATION PERFORMED BADLY In only one case the patient will have the best result

  4. SURGERY OF THE NECKANATOMY • DEFINITION • STRUCTURES: • SKIN, SUPERFICIAL FASCIA, VEINS, NODES • DEEP CERVICAL FASCIA • MAIN ARTERIES, VEINS, NERVES • VISCERA OF THE NECK • THE ROOT OF THE NECK

  5. NECK SURGERY • LUMPS IN THE NECK • WOUNDS OF THE NECK • SURGICAL INFECTIONS IN THE NECK

  6. LUMPS IN THE NECKHISTORY AND EXAMINATION • HISTORY:- rate of growth of the lump, - symptoms:pain, discharge • EXAMINATION- characteristics of the lump- site, shape, size, surface, tenderness, fixation, consistency, fluctuence, pulsatility, associated lymph- adenopathy • Clinical diagnosis- benign or malignant -cystic or solid lump

  7. LUMPS IN THE NECK CAUSES 1. Lymph node enlargement: -lymphomas, -lymph node metastases, -inflammatory lymphadenopathy from acute or chronic infections in the neck, -AIDS related lymphadenopathy 2. Congenital cysts: thyroglossal, branchial, cystic hygroma 3. Lumps in the skin: lipoma, epidermal cyst 4. Rare tumors: carotid body tumors 5. Thyroid and parathyroid nodules

  8. LYMPH NODE ENLARGEMENT CERVICAL TUBERCULOSIS Synonims: tuberculous cervical adenitis :cervical tuberculous lymphadenopathy :mycobacterial lymphadenitis :extrapulmonary tuberculosis

  9. CERVICAL TUBERCULOSIS • Acquired chronic infection of the nodes • Acquired by drinking milk infected cattle • The primary infection occurs in the tonsils • Secondary involvement of the cervical nodes- enlarged, matted together • The incidence of coexisting pulmonary TB is less 5%.

  10. CERVICAL TUBERCULOSISClinical features • Long history of a lump in the neck • Medical advise- the lump has become painful • Presentation: - just lump in the neck - discharging sinus - cold abscess - lump adherent to the skin

  11. CERVICAL TUBERCULOSISClinical features • 90% unilateral • 90% involve only one node group • The commonest- deep jugular vein - submandibular - in the posterior triangle

  12. CERVICAL TUBERCULOSISDiagnosis • History • Physical examination: characteristics of an inflammatory lump • Specific investigations: • Positive tuberculin test • Excisional biopsy of the lump • Culture of Mycobacterium tuberculosis

  13. CERVICAL TUBERCULOSISTreatment • Excisional biopsy • Antituberculous chemotherapy for 9-12 months • Matted nodes attached to the internal jugular vein- functional neck dissection (preservation of the SCM, accessory nerve, jugular vein if possible) *In a kid- remove and examine histologically the tonsils before removing the lymph nodes *Surgery not followed by chemotherapy- a persistent discharging sinus will form and later ugly scar

  14. LUMPS IN THE NECKCAUSES 1.LYMPH NODE ENLARGEMENT: c. ACUTE INFECTIONS d. CHRONIC INFECTIONS

  15. CERVICAL LYMPH NODESCLINICAL ENTITIES • Lymphomas= neoplastic disorders of lymphoid cells • Solid tumors • Involve the lymphoid tissue • Hodgkin’s disease=malignant neoplasm originating in lymphoid tissue • Characteristic Reed-Sternberg cells

  16. CERVICAL LYMPH NODESCLINICAL ENTITIES • Cervical lymph nodes metastases • Primary tumors located in the head neck, chest or abdomen • Tumors of the head and neck, send metastases to nodes- submandibular region and upper part of the anterior triangle • Tumors of the chest and abdomen send metastases to nodes- lower part of the posterior triangle (Virchow’s node)

  17. LUMPS IN THE NECKCAUSES 1.LYMPH NODE ENLARGEMENT: a. PRIMARY TUMORS b. SECONDARY TUMORS -lymphomas- -lymph node metastases-

  18. CONGENITAL NECK LUMPS CYSTIC HYGROMA • Synonim- cystic lymphangioma • Tumor of lymph vessels which forms multilocular cyst- like spaces • Painless lump just below the angle of the mandible, soft, fluctuant, transilluminable • Surgical excision- the best option in fit patients • Incision and drainage when infected

  19. LUMPS IN THE NECKCAUSES 2. CONGENITAL CYST: c. CYSTIC HYGROMA

  20. LUMPS IN THE NECKCAUSES 2. CONGENITAL CYST: a. THYROGLOSSAL CYSTS

  21. CONGENITAL NECK LUMPSTHYROGLOSSAL DUCT CYST • The commonest midline neck cyst • Remnant of the thyroglossal duct- incomplete regression may result in a cyst • It is attached to the base of the tongue and hyoid bone • Painless cystic neck lump, moving up with tongue protrusion, mobile, transilluminable • Tenderness when infected • May drain spontaneouslly with fistula formation • Surgical excision with central part of the hyoid bone

  22. CONGENITAL NECK LUMPSBRANCHIAL CYST • Remnant of the 2nd pharyngeal pouch • Painless lump in the side of the neck, deep to the SCM, 1/3-2/3, anterior triangle • Painful lump if infected, soft, fluctuant • Complete surgical excision or incision and drainage if infected, preventing injuries to the ICA-ECA. • Branchial fistula discharges a glairy mucinous substance

  23. LUMPS IN THE NECKCAUSES 2. CONGENITAL CYST: b. BRANCHIAL CYST

  24. LUMPS IN THE NECKCAUSES 3.LUMPS IN THE SKIN: a. LIPOMA

  25. LUMPS IN THE NECKCAUSES 3.LUMPS IN THE SKIN: b. EPIDERMAL CYST

  26. CAROTID BODY TUMOR • Synonim=chemodectomas • High incidence in Peru, high altitude • Chronic hypoxia at high altitudes leads to carotid body hyperplasia • Firm ovoid tumor, firmly adherent to the bifurcation of the CCA • Painless palpable lump • Seldom grows to more than 4-5 cm.

  27. CAROTID BODY TUMORDIAGNOSIS AND TREATMENT • Long history of a lump in the neck • Physical examination- characteristics of a solid tumor • Investigations- carotid angiogram, doppler echography • Surgical removal- risk of morbidity and mortality • Indications limited for malignant resectable tumors, interfering swallowing, speaking, breathing • Radiotherapy indicated in poor- risc surgical pt. or metastatic diasease

  28. LUMPS IN THE NECKCAUSES 4.RARE TUMORS: CAROTID BODY TUMORS

  29. LUMPS IN THE NECKCAUSES Multinodular goitre

  30. LUMPS IN THE NECKCAUSES Parathyroid adenoma

  31. WOUNDS OF THE NECK • SUICIDAL CUT-THROAT • HOMICIDAL CUT-THROAT • OTHER WOUNDS OF THE NECK

  32. CUT-THROAT • Is due to attempted suicide • Head extended- great vessels escape injury, the air passages are open- repair, tracheostomy • Bleeding from thyroid artery- secured • IJV- ligated above and below the injury site • Pharyngeal injury- suture, septic risk • NG tube for feeding

  33. HOMICIDAL CUT-THROAT • The wound is in the lower part of the neck • Great vessels injured- is fatal • Treatment: • - proper exploration, • - debridement of ischemic tissue, • - repair of damaged structures, • - suture with drainage

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