LIVER BILLIARY TRACT 17 Acute Chlecystitis 2 D/D Investigations Treatment

DIFFERENTIAL DIAGNOSIS

Among the conditions that need to be considered are:

*  Perforation of peptic ulcer

*  Appendicitis

*  Myocardial ischemia

Investigations therefore may include:

*  X-ray abdomen

*  ECG

*  Hepatitis

*  Liver function test and haemogram

*  Serum bilirubin level

*  Oral cholecystography

*  Intravenous cholangiography

*  Ultrasound scan

TREATMENT

Non-operative management is directed at creating functional  rest

for   the  gallbladder  and  upper  gastrointestinal  tract   and

includes:

*  Restriction of fluid and

*  Continuous nasogastric suction

*  Pain is treated with small amounts of analgesics and

*  Use of antibiotics

If  early operation is performed, cholecystectomy, which  can  be

carried  out  with  a  low mortality  rate  sppes  the  patient's

recovery.

Most  surgeons,  however, prefer to treat the  acute  phase  with

antibiotics  and  control the  infection,  cholecystectomy  being

taken up after elimination of infection (6-12 weeks)

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HEAD NECK 12 Tongue Cancer

5.3 TONGUE

 

Carcinoma originates at the tip or along the free borders:   Area

of hyperkeratosis develops first.

 

Later  this  develops  into an ulcerated  lesion  with  exophytic

undermined border.

 

Palpation  detects  hardness  and  indicates  that  invasion  has

occurred beyond the ulcer.

 

Spread   cancer  of  the  tip  of  the  tongue  metastasises   to

ipsilateral sub mandibular nodes and later the nodes at the  angle

of  the mandible are involved. 

 Forty percent have nodes  at  the time of presentation.

 

CLINICAL

 

The patient presents with :

-  Pain

-  Salivation

-  Fixation of Tongue

-  Dysphagias

-  Difficulty in speech

-  Foetor

 

Diagnosis

 

Multiple biopsies establish the diagnosis and the extent in large

tumours.

 

TREATMENT

 

T1NoMo lesions can be treated by radiotherapy or surgery as small

lesion  is  removed  with 1.5 cm margin  of  healthy  tissue  all

around.  Lesion of upto 1cm can be treated by interstitial radion

with Iridium192 wire. 

 

Combined  operation  including  wide resection of  a  small  oral

lesion  if  they  have nodes at the time  of  presentation,  they

require radial neck dissection.

 

Treat  all  larger lesions with preoperative  radiation  therapy,

following  this with a radical neck dissection and in  continuity

excision of any residual cancer.

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HEAD NECK 10 Malignant tumors Lip

5. MALIGNANT TUMOURS

Sqaumous cell carcinoma make up the majority of all carcinomas of

the oral cavity, highly differentiated tumours occur less  often,

anaplastic lesions are rare.

Adenocarcinomas are met with and originate in the minor  salivary

glands.

5.1 LIP

Squamous cell carcinomas are the common malignant tumours of  the

lip  and  represent  nearly 15% of all  head  and  neck  cancers.

Basal cell carcinomas are less frequent.

ETIOLOGY

Important relationship exists between tumours of lip and exposure

to sunlight.

*  Complexion plays a role, susceptible are the fair skinned  and

   ligh haired.

*  Dark haired and dark skinned individuals are resistant.

*  Tobacco   chewing  and pipe smoking have been suspected  as  a

   cause of lip cancer.

*  It  is possible that the stems of wood and clay pipes soak  up

   tobacco tar directly and cause the disorder.

PATHOLOGY

*  The  tumour is a squamous carcinoma and occurs most  often  on

   the lower lip.

*  It is low grade well diffentiated lesion

CLINICAL

*  Lower lip in the site in 70%

*  Though slow growing, some patients may present when the lesion

   has reached a large size, destroying the entire lip.

*  There may be cervical lymphnodes, usually submental nodes.

*  An  ulcer of the lip which fails to heal should  be  suspected

   early.

TREATMENT

*  Treatment  for  small lesions is local  excision  under  local

   anaesthesia.

*  Radiation can also achieve good results in lesion below 2  cm.

   and can be given as outpatient therapy.

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