Examination

CASE 1 :
Mrs.Nurani a healthy 30 years old woman reports
difficulty swallowing liquids and occasional
regurgitation.
Manometric studies show an increase the
pressure in the body of the esophagus.

What is the most likely diagnosis ??

Where is the patho

logig feature in this
Slide ?
How many stage of
that case ?

What is the basic pathology of this

disorder ?? ,symptoms ??
What is the best treatment of this
desease?
When do you perform radical
resectional surgery??

How many kinds of funduplication

NISSEN.
Belsey Mark IV.
Hill.
D Or.
Toupet.

GERD
Approximately 75% of Esophageal

pathology.
Symtoms : heartburn, nausea, vomiting,
post prandial fullness, chest pain, choking.
Complications : esophagitis, stricture, Bar
retts esophagus, pulmonary fibrosis.
Treatment : Medical.-- ??
Surgical. Indication ??

A 45 years old man presents with rectal bleeding

and mucus discharge that have persisted for 3
months. The mucus now has a foul odorant
appears between bowel movements. Recently he
has a sense of incomplete evacuation, different
from usual.
There are no cramps, no change of appetite, and
no weight loss.
He was seen 1 month previously by a physician
who told him that he has a hemorrhoids and that
he should take a sitz bath and take a medicine,
but the condition did not get better.
What is your diagnostic suggestion of this
patient??.

What is the imaging techniques to

assess invasion or metastasis ?
CT scan with or without contrast.
Magnetic resonance imaging (MRI).
Positron emission tomography (PET).
Transrectal ultrasonography (EUS)
Monoclonal antibody.
Virtual colonoscopy.

What kinds of diagnostic methods do you

perform? How is the standard diagnosis?.
What is your comment about preoperative
radiation?.
Do you agree with the laparoscopic
procedure for the treatment of colon
carcinoma?
How is the staging of Colon cancer ?

Tell us about surgical treatment

and how about chemotherapy?

How is the preparation of colon surgery?

How is the technical operation for rectal
cancer ?.
Tell us about the Chemoterhapy.
How is the follow up after Surgery?.
How is the management of Obstructing
Colon Cancer ?? ( right, left and rectal ).

A 56 year old diabetic man is

admitted to the emergency room
for right upper abdominal
discomfort and jaundice.
He vomited once, temperature of
39, pulse rate was 112 and
severe chills. A right upper
quadrant globular mass is
palpated.
What other history will you ask?.

An elderly man who presents with chills,

fever and jaundice, what do you think ?

What kinds of examination should be

done? And what is the reason.
What bacteria are involved in
cholangitis or cholecystitis ?
Why can cholangitis not be
satisfactorily treated only with
antibiotics ?
What is the cause of cholangitis ?

If you get a patient with choledo

chus stone what will you do ?

What is the basic pathology of

pyogenic cholangitis ?
What kinds of surgical interventions
in a case of distal choledochus
striture ?

Mrs. Fatimah ( 76 years )

Abdominal colic 5 days, nausea and

vomit, flatus (-), defecation (-).
Abdominal distension, bowel sound +
++, no ascites and no mass was
palpabled.
Rectal toucher : collaps, no fecal
material and no blood.

DIAGNOSIS?
OTHER EXAMINATION ?

TREATMENT
SURGERY

CHEMOTHERAPHY

Mrs. Sri Astuty, 51 years old.

Suffered from 1 month jaundice.

Insomnia, epigastric pain and back
pain.
Itching and faecal was acholis.
Epigastric mass.
Physical diagnosis ?
Radiological examination ?.
Endoscopy ?.

Contraindicating resection

Liver metastases ( any size )

Celiac Lymph node involvement
Peritoneum implants
Invasions of transverse mesocolon
Hepatic hilar lymph node involvement

Not contraindicating resection

Invasion at duodenum or distal
stomach
Involved peripancreatic lymph
node
Involved lymph node along the
porta hepatis that can be swept
down with the specimen.

Palliative Chemotherapy

Indication ?

Medical treatment ?

Surgical treatment ?