GENERAL SURGERY

Submitted by L. Sahaya jenitta 3 rd year BDS

Content
Tumours Ulcers Cysts Sinus Fistulae

TUMOURS
Neoplasms are uncoordinated and purposeless growth of tissue. TYPES: 1. Benign 2. Malignant BENIGN TUMOURS: Benign tumours, grow by expansion usually grow more slowly, better differentiated, often have a fibrous capsule.

CLASSIFICATION: 1. Epithelial neoplasms, Adenoma Papilloma Hamartoma 2. Connective tissue neoplasms, Lipoma Fibroma Neurofibroma PAPILLOMA: This is a benign tumour arising from skin or mucous membrane. It is characterised by finger like projections with a central core of connective tissue, blood vessels, lymphatics and lining epithelium. It can be called hamartoma or a skin tag. TYPES: i. Skin papilloma: Squamous papilloma Basal cell papilloma Arising from mucous membrane of visceral organs: Transitional cell papilloma

ii.

Columnar cell papilloma Cuboidal cell papilloma Squamous papilloma Papilloma of breast TREATMENT: Excision,only if papilloma causes discomfort,or if it is symptomatic.

HAMARTOMA: It is a tumour like developmental malformation of the tissues of a particular part of the body wherein it is arranged haphazardly. Hamartoma is a Greek word which means fault or misfire. TREATMENT: Excision is not only curative but also gives a correct diagnosis. Care should be taken. LIPOMA: Lipoma is a benign tumour arising from fat cells of adult type. TYPES: i. ii. iii. Single subcutaneous lipoma Multiple lipomatosis Uncapsulated lipoma

TREATMENT: Excision of lipoma is done by incising the skin followed by dissecting it all around. FIBROMA: It is a benign tumour,consisting of connective tissue fibers only. TYPES: i. ii. Soft fibromas Hard fibromas Neurofibroma Fibrolipoma Myofibroma

Angiofibroma TREATMENT: Excision MALIGNANT TUMOURS: They are, grows by expansion as well as by infiltration. This property of infiltration that makes malignant neoplasms so dangerous. They infiltrate into neighbouring tissues. This is direct spread. CLASSIFICATION: Carcinoma Sarcoma Teratoma CARCINOMA: Carcinoma arises from epithelium. ORIGIN: Ectodermal skin cancer Endodermal gut cancer Mesodermal renal carcinoma TYPES: Squamous cell carcinoma Basal cell carcinoma Adenocarcinoma Glandular

PATHOLOGY: Spread 1) Local spread 2) Lymphatic spread a) Permeation b) Embolisation c) Retrograde lymphatic spread

Haematogenous spread Seeding Transcoelomic spread AETIOLOGY: Tobacco Alcohol Ionising radiation UV radiation Genetic causes Hereditary causes Dietary factors Chemicals Viral factors

TREATMENT: o Surgery for endodermal cancers o Radiotherapy for ectodermal lesions o Chemotherapy. SARCOMAS: These are the malignant tumours arising from soft tissues.Thus they can occur in any part of the body. These are malignant tumours which are fatal if untreated or mistreated. Most of them occur in young patients,as painless lumps. TYPES: Liposarcoma Fibrosarcoma Neurofibrosarcoma Osteosarcoma

PATHOLOGY: Sarcomas generally spread rapidly,mostly by the blood stream.Liver and lung secondaries are common. AETIOLOGY: 1) Lymphangiosarcoma 2) Angiosarcoma 3) Osteogenic sarcoma

4) Fibrosarcoma 5) Kaposis sarcoma CLINICAL FEATURES: Origin from mesodermal. Occurs in youns,age 10 -30 years. Rapid growth. Fleshy mass,red and vascular,dilated veins over the surface. Local rise of temperature. INVESTIGATIONS: CT scan MRI Incision biopsy TREATMENT: Surgery Radiotherapy Chemotherapy.

ULCERS
An ulcer is a discontinuity of the skin or mucous membrane which occurs due to the microscopic death of the tissues. Thus,ulcer can occur anywhere in the body,oral cavity,penis or in the duodenum,intestine,etc. CLASSIFICATION: Nonspecific Ulcers Traumatic Venous Arterial Neurogenic Trophic Tropic Diabetic Blood dyscrasias Specific Ulcers Malignant Ulcers CLINICAL FEATURES: Ulcer consists of an edge,a floor and a base. Edge slopes in a healing ulcer; In gummatous and neurotrophic ulcers,it is punched out. It is undermined in a tuberculous ulcer. In basal cell carcinoma,the edge is raised but not rolled out; In squamous cell carcinoma,it is raised and rolled out. The fioor of healing ulcer is bright red. Malignant ulcers get fixed to the underlying structures,will become immobile. In non specific ulcers,the regional nodes will be firm and tenderness. INVESTIGATIONS: Complete blood picture Urine and blood examination Chest X-ray Pus for culture

 Lower limp angiography Biopsy TREATMENT: a) Treatment of spreading ulcer: Appropriate antibiotics are given like hydrogen peroxide and EUSOL. b) Treatment of healing ulcers: Regular dressings with antiseptic creams. c) Treatment of chronic ulcers: These are not respond to conventional methods of treatment. IR radiation,short-wave therapy,UV radiation. Amnion helps in epithelialisation. Chorion helps in granulation tissue. d) Treatment of the underlying disease. DIFFERENTIAL DIAGNOSIS: o Traumatic ulcer o Varicose ulcer o Arterial ulcer o Diabetic ulcer o Neurogenic ulcer o Tropical ulcer

o Post-thrombotic ulcer o Malignant skin ulcer o Martorells ulcer

CYSTS A cyst is a swelling containing fluid.True cysts are lined by endothelium or epithelium.They contain clear serous fluid,mucoid material,pus,blood,lymph material False cysts do not have lining epithelium. CLASSIFICATION OF CYST: I. Congenital cyst Sequestration dermoid cyst Branchial cyst Thyroglossal cyst Lymphangioma Acquired cyst Retention cyst-Sebaceous cyst,galactocele,spermatocele,Bartholins gland cyst Distention cyst-Thyroid cyst,ovarian cyst Exudation cyst Hydrocele Degenerative cysts Tumour necrosis Traumatic cyst Cystic tumours Parasitic cyst

II.

III.

 Cysticercosis Hydatid cyst CLINICAL FEATURES: 1) LOCATION:Most of the congenital cystic swellings have a typical location can be made with fair accuracy. 2) SHAPE:Majority of cystic swellings are round or oval. 3) SURFACE:Smooth surface 4) CONSISTENCY:Fluctuation is positive. 5) TRANSILLUMINATION;Cystic swellings which contain clear fluid show positive transillumination. 6) MOBILITY:They should have free mobility. EFFECTS OF ANEURYSM: Thrombosis Ischaemia Pressure Skin Changes

COMPLICATIONS OF CYSTS: Infection Calcification Pressure effects Haemorrhage Torsion Transformation Overian cachexia TREATMENT: Excision

Incision Marsupiliation

SINUS
A sinus is an abnormal blind track that discharges onto skin or mucous membranes.It is lined with granulation tissue. TYPES: Non specific sinus Osteomyelitis Tuberculous sinus Preauricular sinus Median mental sinus Pilonidal sinus Maduramycosis CAUSES: Presence of foreign body Persistent infection Distal obstruction Absence of rest Epithelialisation of the track Malignancy Dense fibrosis Irradiation Specific causes TB,Actinomycosis.

CLINICAL FEATURES: 1) It can be single or multiple. 2) Opening sprouting granulation tissue forign body.Flush with skin Tuberculosis. 3) Discharge white thin caseous in tuberculosis,yellow purulent.

4) Surrounding skin:red,angry looking,inflammatory,bluish discoloration,pigmentation. 5) Temperature and tenderness is increased if there is inflammation of the sinus. INVESTIGATIONS: Complete blood picture ESR Urine sugar,fasting blood sugar and post prandial blood sugar. X ray of the part of the body. Sinusography Biopsy.

TREATMENT: Antibiotics Adequate rest Adequate excision Adequate drainage.

FISTULAE A fistulae is an abnormal track connecting an epithelial lined cavity to the skin or connecting two epithelial lined cavities. TYPES: 1) Internal fistulae Tracheo-oesophageal fistula Colovesical fistula

2) External fistula Orocutaneous fistula Branchial fistula Thyroglossal fistula CAUSES: Presence of foreign body Persistent infection Distal obstruction Absence of rest Epithelialisation of the track Malignancy Dense fibrosis Irradiation Specific causes TB,Actinomycosis

CLINICAL EXAMINATION: Location gives the diagnosis in the majority of the cases of fistula. It can be single or multiple. Discharge yellow granules, Thin mucous discharge from branchial fistula Urine from urinary fistula. Surrounding skin shows red,inflammatory,bluish discoloration, Skin excoriation in Faecal fistula.

INVESTIGATIONS: Complete blood picture ESR Urine sugar,fasting blood sugar and post prandial blood sugar. X ray of the part of the body. X ray kidney,ureter,bladder region, Fistulography, Biopsy.

TREATMENT: Antibiotics

 Adequate rest Adequate excision Adequate drainage.

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