Jaundice

Jaundice is yellow discoloration sclera, mucosa and skin due to increase in bilirubin (visibile >350micromol)

Causes:

• prehapatic: heamolytic aneamia
• hepatic : hepatitis, hepatocellular, alcoholic hepatitis, cirrrosis, met liver, 
• post hepatic: acute cholangitis, ca of head pancrease
• drug: anti-TB, statin, sodium valporate, anti-malaria, pcm Overdose.

 in history : must ask about IVDu, blood tranfusion, sexual activity, fam hx,

aneurysm

1. Aneurysm is dilated arterial. Usually find at aorta, thoracic, illiac and femoral. In this: more to AAA

2. Symptopms: usually assymtopmatic. Abdominal pain, back pain, pursatile sensation of abdomen,raping rasing of HR after stading. Must recognise whether patient in rupture of vessel (hypotension, abdominal pain, Also can cause heart failure.  Hence, must ask also about shock symtoms and sign and also sign of peritonitis. 

RF:

• infection: sypilis, mycotic
• inflamatory : polyarteritis, Polyarteritis Nodosa
• congenita: Ehler danlos syndrome, Marfan syndrome, Tuberous Sclerosis.

3. on examamination: there is a mass at epigastric area extanding to... the mass is non tender, soft, pursatile, expanxile. on ausculation, ??

4. complication:

• rupture
• compression: nerve (paraplegia), pluqeu rupture (embolism, thrombembolism-  distal ischemia), posterior erosion (back pain)

5. Ix

• specific:Us to look for any mass, to measure the dilation, Axr- calcification
• other : CT/MRA
• interpretation:   if less then 5:wait and see, if >.5cm5 surgery, if <5>

6. Management:

• Medical : propanolol, doxycycline Repair. (open or)
• surgery: open AAA repair vs endovascularrepair (covered stent placed via femoral arteriotomy under radiological guidanance

7. Post op management: 

• Consent
• nutrition: 2day - low residual diet, 2days- fluid diet
• cover - abx (2 days bfr)
• dvt prophylaxis - LMWH
• sent blood group cross match and hold.
• bowel prep
• chest physiotheraphy
• cell saver

8. Complication- immediate, early, late cam besa la..

Skin lesion.

Skin layers:

a) epidermis: stratum corneum (keratin), granular cell layer, princkle cell layer, basal cell layer and melanocyte.

b) dermis

c) subcutanous

D) vascular

(MR. imran ques: function of skin )

Protocol from Prof Lee: 4S, CET, PMS.

1. Epidermis: 

Benign

• skin tag (papilloma)
• warts
• seborrhoeic keratoses
• Keraton acanthoma 

premalig

• solar keratoses
• bowens disease
• erythoplasia of Querat

malignant

• SCC
• BCC

Melanotic lesion

• benign pigmented naevi
• malignant melanoma

2. Dermis

• pyogenic granuloma
• histocytoma
• keloid
• secondary ca
• Kaporsi sarcoma

3. Lesion from skin appendages

• sebacous cysts (at hairy area, 50% punctum, origin: outer sheath of hair follicle, content epthelial emennts )
• dermoid (hard, origin : epithelial remnant, midline)
• pilonidal sinus

infection: Faruncle, carcucle (s.c) tx: I n D, abx

4. Subcutaneous and deeper

• lipoma/liposarcoma (slip sign  positive, lobulated, compressible, move all direction, )
• neurofibroma and sarcoma
• neurofibromatosis
• schwannoma
• deeper lesion : ganglion ( near join and tendon, if superficial to tendon move at right angle, if deep will not move)
  

5. Vascular origin

• campbell de Morgan spot
• spider neavi
• angiomas
• glomus tumour of digit.

6. Muscle

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