for general surgery

1. CYSTS
&
ULCERS

2. CYSTS
• Cyst is a fluid filled sac bound by a wall.
• Fluid is often clear, colorless or
cholesterol crystals, or tooth paste like.
• True Cyst: lined with epithelial or
endothelial cells.
• False Cyst: which are walled off fluid
collection not by epithelium
e.g. Pancreatic pseudocyst

3. Classification
 Congenital
 Acquired

4. CONGENITAL
CYSTS
• Sequestration dermoid
• Tubuloembryonic
• Cysts of embryonic remnants
– Hydatid of Morgagni
– Cysts of the urachus
– Cyst of vitellointestinal duct
– Cysts of wolffian duct
• Branchial Cyst
• Thyroglossal Cyst

5. ACQUIRED
CYSTS
• Retention cysts
• Cystic tumours
• Implantation dermoids
• Traumatic cysts
• Degeneration
• Parasitic cysts
– Hydatid,
– trichniasis,
– cysticercosis

6. • Sequestration dermoid:
• This is due to dermal cell being buried
along to the lines of closure of embryonic
clefts and sinuses by skin fusion.
• Lined by epidermis and containing paste
like material.
• Sites midline of body
• outer canthus
• anterior triangle of mouth.

7. • Tubuloembryonic cyst:
• in the track of ectodermal
tube development.
• e.g: thyroglossal cyst, ependymal
cyst.

8. • Acquired cyst:
• Retention cyst:
• due to accumulation of secretion in
gland behind an obstruction of a
duct.
• e.g: sebaceous cyst, Pseudu
pancreatic cyst, parotid gland cyst.

9. • Distension cyst:
• occur in thyroid from dilatation of
acni.
• cystic hygroma and lymphatic
cyst.

10. Exudation Cyst
• Exudative fluid accumulate in
endothelium lined anatomical space.
• e.g: Hydrocele, bursa.

11. Cystic tumor
• e.g: cystic teratoma, cystadenoma.
Implantation dermoid
• Squamous epithelium driven beneath
skin by penetrating wound.

12. Clinical Features
• Varies according to the site & size
• Pain → enlarging cysts,
• Pain → Secondary to haemorrhage,
infection, rupture, torsion
• Acute abdominal emergency: torsion
or rupture of ovarian cyst

13. Clinical Features
Compression symptoms resulting from
compression of adjacent structures
Haemorrhage in thyroglossal cyst →
increase in size → compress the
trachea
Large ovarian cyst → abd: fullness &
reduced appetite resulting from raises
I/abd: pressure
Obstruction to pelvic veins → varicose
veins of lower limbs

14. COMPLICATIONS
1. Infection
2. Haemorrhage
3. Torsion
4. Obstruction
5. Calcification
6. Malignancy ( very rarely)

15. INVESTIGATIONS
Signs: Fluctuant, transilluminant if
containing clear fluid
Diagnosis: obvious in cases of superficial
cysts
Deep seated intra-abdominal or thoracic
cysts need U/sound, CT scan, MRI

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17. Page No. 14

19. Page No. 209

20. ULCER
• An ulcer is a break in the continuity
of an epithelial surface.
• Characterized by progressive
destruction of the surface epithelium
and a granulating base which may
clean, healthy or containing necrotic
slough

21. Clinical Examination
• Size
• Shape
• Edge
• Floor
• Base
• Discharge
• Surrounding area
• Lymph nodes
• Pain
• General exam:
• Pathological exam:

24. Marjolin’s ulcer
• Malignant change occurring in any
long standing benign ulcer
irrespective of its cause.
• Change usually occurs at the edge of
a chronic ulcer

25. Management
• Treatment of cause
• Accurate assessment of the ulcer
• Identify & correct the co - morbid factors
• Adequate drainage & desloughing
• Antiseptics and topical antibiotics
• Wound dressings
– Hydrogel
– Alginates
– Lyofoam
– Tegaderm
– Alleyvn

26. Page No. 08

27. Page No. 07

28. Page No. 176

29. Page No. 173

30. SINUSES
• A sinus is a blind tract usually lined
with granulation tissue that leads
from an epithelial surface into the
surrounding tissue.
• e.g. pilonidal sinus

31. FISTULA
• It is a communicating track between
two epithelial surfaces, commonly
between a hollow viscus and the skin
( external fistula) or between two
hollow viscera ( internal fistula)
• The track is lined with granulation
tissue which is subsequently
epithelialzed

33. CLASSIFICATION
 Congenital
 Acquired

34. Pathological sinuses
• CONGENITAL
1. Preauricular
2. Umbilical
3. Urachal
4. Coccygeal
5. Sacral
• ACQUIRED
1. Pilonidal
2. Suture
3. Post-surgical
4. Actinomycosis
5. Tuberculosis
6. Osteomyelitis

35. Persistence of a sinus or fistula
• F Foreign Body & Necrotic Tissue
• R Radiation
• I Immunosupression
Infection
Ischemia
• E Epithelization
• N Neoplasia
• D Drugs (eg: Steroids , Cytotoxic drugs)
Distal Obstruction
• S Systemic Diseases (eg: AIDS)

36. Clinical features
• Asymptomatic
• Recurrent or persistent discharge
• Pain
• Infection

37. Diagnosis
• Assess the accurate direction, depth
& presence of multiple tracts.
• Microbiological examination of
discharge ( gut organism, actinomycosis,
tuberculosis)
• Sinogram

38. Management of Sinus
• Complete excision of all sinus tract.
• Sinus is laid open or excised
• Biopsy of tissue is sent
• Removal of the cause