general surgery viva - xrays and specimen

1. Dr. Mohammad Masoom Parwez
Academic Resident
AIIMS Bhopal

2.  Barium swallow -- esophagus
 Barium meal--- stomach and duodenum
 Barium meal follow through--- small and large gut

11.  Smooth narrowing, no irregularity of mucosal lining
 Due to loss of ganglion cells in myenteric plexus
 Retention of food and fluids– dilatation of esophagus– recurrent aspiration
pneumonitis--- increased incidence of CA
 Pseudoachalasia– due to intraluminal growth/ extraluminal compression
 Presentation: young adults/ dysphagia to liquids– solids & liquids/ retrosternal
discomfort/ regurgitation/ aspiration pneumonia/ weight loss and anemia
 Inv: endoscopy, manometry
 Medical mx: CCB oral nifedipine, botulinum toxin inj
 Surgical Mx: endoscopic dilatation, Hellers cardiomyotomy with partial fundoplication

13.  Irregular/ incoordinated contractions – high intraesophageal pressure (400-500 mm
Hg)
 Marked hypertrophy of circular muscles
 Presentation: Dysphagia, chest pain
 Cork screw esophagus
 Treatment: esophageal dilatation, long esophageal myotomy

18.  Presentation: dysphagia to solids– both solids and liquids/ regurgitation/ anorexia &
weight loss/ hoarseness/ neck mass/ hematemesis/ melena
 Inv: endoscopy – biopsy, EUS, CT
 Staging– AJCC 8th edition
 Spread: direct/ lymphatic/ distant
 Predisposing factors: diet, smoking, alcohol, barretts esophagus, achalasia, chr
esophagitis
 Types: squamous/ adenoCA
 Sx: subtotal/ total esophagectomy with esophagogastric anastomosis + CT/RT
 Palliation: stenting, laser/electrocautery to excise tumor, brachytherapy

34.  Barium enema
 DCBE

36. Saw tooth
appearance

37. Rose thorn ulcers

38. String sign of
kantor

39. Lead
pipe
colon

44. Apple core

46. ERCP
T- tube cholangiogram

56. Breast and lymph node

62.  Based on cells of origin:
 Ductal – epth cells lining the ducts
 Lobular-- cells lining lobules/acini
 Pathological types:
 Carcinoma in situ– upto basement memb
 Infiltrating– basement memb breached; invade connective tissue
 Scirrhous– small unencapsulated tumor with diminished vascularity; cuts with gritty sensation
 Medullary– young women; tumor bulky but softer
 Colloidal– bulky, soft tumor; microscopically cells abundant in mucin; signet cells
 Inflammatory– highly aggressive, poor prognosis, breast swollen, warm, painful with rich
vascularity
 Pagets disease of nipple– eczema over NAC– eventual destruction, large ovoid pagets cells
with abundant cytoplasm

63.  Skin changes:
Peau d’ Orange: orange peel appearance–
subdermal lymphatics– skin tense, thickened and
edematous
Tethering: coopers ligament, skin dimples on
pushing the lump
Skin nodules: direct invasion of the skin
Cancer en cuirasse: advanced stage; skin
become fixed and indurated, satellite nodules,
involves whole of breast

64.  Risk factors:
 Age
 Sex
 SES
 Diet
 Addiction
 Early menarche, late menopause, late first pregnancy
 HRT/OCP
 Prior radiation
 Family history
 Genetic
 Prior breast CA

65.  Modes of spread:
 Direct: adjacent quadrant; chest wall; pectoral muscles; serratus anterior; overlying
skin
 Lymphatic: permeation and embolization; axillary and internal mammary nodes; supra
and infraclavicular nodes, opposite breast and axilla; peritoneum and ovaries
 Hematogenous: bones (lumbar vertebra, femur, thoracic vertebra, ribs, skull); liver;
lungs; brain; adrenal; ovaries