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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
A 19-year-old female presents with increasing right iliac fossa pain, nausea and fever. She denies any PV discharge. On examination her abdomen is soft, diffusely tender in the suprapubic region with possible right adnexal tenderness. One of the most helpful exercise I did towards the end of my interview practice, once I had been through enough stations, was tangential learning. I would run through a clinical topic like appendicitis and then pick on subjects from my answer and expand on them, for example. Meckels’ diverticulitis, blood investigations, consenting patients, etc. The experience of going through enough stations is that you can start to think through scenarios, and second-guess where interviewers are likely to ask you questions. Practise as many station scenarios as you can to reacquaint yourself with the clinical knowledge. I found it helpful to constantly think what I had seen my registrars doing – like phoning theatres and reviewing relevant test results. Perhaps the most important principle is to be safe, always think: What is the safest thing to do for my patient?
The vermiform appendix
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Rectus sheath haematoma is a relatively rare but easily missed differential diagnosis. It usually presents with acute pain and localised tenderness in the right iliac fossa, often after an episode of strenuous physical exercise. Localised pain without gastrointestinal upset is the rule. Occasionally, in an elderly patient, particularly one taking anticoagulant therapy, a rectus sheath haematoma may present as a mass and tenderness in the right iliac fossa after minor trauma.
Laparoscopy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Farr Nezhat, Carmel Cohen, Nimesh P. Nagarsheth
The appendix is an elongated vestigial diverticulum of the cecum, which is richly endowed with lymphoid tissue. It is normally 7 to 10 cm in length but lengths up to 30 cm have been recorded. It receives blood supply from the appendicular artery, which is a branch of the lower division of the ileocecal artery. An accessory appendicular artery may be present in almost 50% of patients. The major vessels enter the mesoappendix a short distance from the base of the appendix. The location of the appendix is variable; up to 70% will be retrocecal and the remainder present primarily in front of the large bowel. Although it is usually found in the right iliac fossa, in maldescent of the cecum or advanced pregnancy the appendix may be seated in the right hypochondrium. In rare conditions, such as situs inversus, the appendix is in the left iliac fossa.
Mucinous cystadenoma with fibroma: a rare combination of collision tumour
Published in Journal of Obstetrics and Gynaecology, 2022
Tanisha Singla, Chintamani Pathak, Anam Singh, Gaurav Singla, Swati Singla, Naveen Kumar R.
A 50-year-old postmenopausal female presented with complaints of progressive abdominopelvic discomfort over a year, associated with the development of a lower abdominal lump for the past 10 months. She had a past history of total abdominal hysterectomy done 12 years back for uterine leiomyomas. Her general physical examination was within normal limits. There was no history of any hormonal symptoms. Systemic examination of the abdomen revealed a large lower abdominal mass in the left iliac fossa measuring approximately 15−20 cm in size. An MRI revealed a large 200 × 180 × 60 mm well circumscribed left ovarian mass having heterologous low signal intensity with associated mild ascites on T2W imaging. T1W delayed post contrast axial MRI imaging showed heterologous enhancement of the left ovarian mass (Figure 1(A)). No pleural effusion was seen. Clinically fibroma of left ovary was suspected. Tumour markers, like CEA and AFP, were within normal limits but CA 125 levels were mildly raised. The patient underwent a left salpingoopherectomy.
Clinical features and outcomes of childhood polyarteritis nodosa: A single referral center experience
Published in Modern Rheumatology, 2021
Nilüfer Tekgöz, Fatma Aydın, Tuba Kurt, Müge Sezer, Zahide Tekin, Cüneyt Karagöl, Nilgün Çakar, Banu Acar
Skin biopsy was performed in five patients which revealed necrotizing vasculitis in medium-sized arteries. The other four biopsy samples were obtained from kidney, muscle and appendix. Patient no. 5 was presented with fever and a constant abdominal pain localized in the right iliac fossa. A physical examination revealed a generalized abdominal tenderness, more prominent in the lower abdomen with guarding and rebound tenderness. Abdominal ultrasound showed findings supportive of the diagnosis of appendicitis. The patient underwent an appendectomy. Livedoid rash started on her lower limbs 2 weeks after the operation. The pathology result of the appendectomy specimen was reported as PAN which showed fibrinoid necrosis in small-medium-sized arteries. Patient no. 4 was presented with fever, myalgia, abdominal pain, arthritis, macroscopic hematuria, edema and hypoalbuminemia. Spot urine protein/creatinine ratio was 3.5 and 24-h urine protein was 60 mg/m2/h. Renal biopsy was performed and showed fibrinoid necrosis in small-medium-sized arteries.
Appendiceal sarcoidosis presenting as acute appendicitis
Published in Baylor University Medical Center Proceedings, 2020
Venkata Satish Pendela, Anisleidys Munoz, Mamta Chhabria, Pujitha Kudaravalli, Megan Soliman, Youssef Soliman
The patient was hemodynamically stable on arrival with a blood pressure of 120/70 mm Hg and a heart rate of 103 beats/minute. Palpation of the right iliac fossa disclosed tenderness. One hour after admission, the patient had an episode of nonbilious vomiting containing food particles. Her hemoglobin level was 11.2 g/dL; sedimentation rate, 9 mm/h; and white blood cell count, 4.2 × 103/µL. An ultrasound of the abdomen was suggestive of acute appendicitis with McBurney’s point tenderness. A computed tomography (CT) scan of the abdomen showed an appendicular mass. Magnetic resonance imaging (MRI) of the spine done just prior to this admission (for back pain) showed hypoechoic lesions concerning for vertebral metastases. A fluorodeoxyglucose–positron emission tomography scan done at the same time revealed extensive metastatic lesions with nodular uptake in the right upper lobe of the lung, numerous mediastinal lymph nodes, hypermetabolic foci in the axial skeleton, and focal hypermetabolism in the mid to distal appendix (standardized uptake value 3.8), concerning for an appendiceal neoplasm (Figure 1).