Download Paper 1 Q 2 DD of mass in rt iliac fossa (enumerate the most

Paper 1 Q 2
DD of mass in rt iliac fossa (enumerate the most common causes
and investigation)
Right iliac fossa mass is a common clinical presentation and has a
range of differentials that need to be excluded. Radiology plays an
important role in this differentiation.
Differential diagnosis
 appendicular mass
o appendicular abscess
o appendicular mucocele
o appendicular neoplasma
 ileocaecal tuberculosis (hyperplastic type)
 intussusception
 carcinoma caecum
 tubo-ovarian mass, e.g. abscess and neoplasm
 undescended testis
 transplanted kidney
 ectopic kidney
 psoas abscess
 non-Hodgkin lymphoma
 rt iliac artery aneurysm
Investigation:
 Laboratory
CBC: leucocytosis in aappendicular abscess
Leucopenia with TB
o Tumour markers : ovarian tumours
o PCR and tuberculin test :TB
o
o Blood film : lymphoma.
 Radiological
o X ray :calcified lymph nodes in TB
Obliteration of psoas shadow in appendicular
abscess
o
o
o
o
Ultrasound: distinguish a bowel mass from an ovarian or
utrine mass, any lymph nodes or abnormal blood vessels.
CT scan for abdominal wall masses and this would also be
useful in looking at the extent of intra- abdominal
malignant disease
Intravenous contrast-enhanced CTscanning would
clarify lower abdominal and pelvic vasculature.
Pathological analysis by cytology for aspiration and
histology for biopsies
Paper 1 Q 8
DVT is a blood clot that has formed in a vein.
Risk factores
Surgery, trauma, burns ,Obesity ,Malignancy, Prolonged
immobilization
Diabetes, Inflammatory bowel disease
Protein C, S, or antithrombin III deficiency
Nephrotic syndrome, Polycythemia vera
Dysfibrinogenemia , Acute leukemia, Infection
Pregnancy, Oral estrogen therapy
Sickle cell disease,Congestive heart failure
Hemoglobinuria, Lupus anticoagulant disorder
Varicose veins
Behçet’s disease
Homocysteinemia
Investigations:
1. Doppler ultrasound:
It is a simple and rapid method and is accurate in 8085% of cases.
2. Duplex ultrasound: This method combines Doppler ultrasound
flow analysis with ultrasound imaging. Its sensitivity and specificity
reach 90-100%
3. Ascending venography is the gold standard but it is invasive
method.
4. 125I-fibrinogen uptake depends upon the incorporation of isotope
labelled human serum fibrinogen into the developing thrombus. Any
increase in radioactivity is detected with a scintillation counter. It is
very accurate in the calf and lower thigh.
5. Other tests as plethysmography and venous pressure measurements
are of academic interest.
prophylaxis
1 . Physical measures to reduce venous stasis:
a. Early ambulation after operations.
b. Active leg exercise.
c. Elastic stocking support especially in the elderly.
d. Adequate postoperative hydration.
e. Intermittent pneumatic external calf compression by special
devices.
f. Elevation of the foot of the bed.
2. Prophylactic anticoagulation:
In high risk patients, one of two methods may be employed.
A- Low dose unfractionated heparin
5000 IU subcutaneous 2 hours before operation and then every 12
hours until the patient is ambulant,
It is proved to be very effective in lowering the incidence of DVT
by 50%.
B- Low molecular weight heparin (LMWH):
Started the night before surgery and then given every 12 hours
postoperatively.
Dose: 20-40 mg SC every 12 hours according to body weight and
degree of risk.