19. Gallbladder cancer, Anorectal fistulas and abscesses, pilonidal sinus & Acute appendicitis in childhood

What is the definition of GALLBLADDER CANCER?

Gallbladder cancer originates within the mucosal lining of the gallbladder. It is the most common malignant lesion of the biliary tract, with most tumours being adenocarcinomas.

What is the classification of GALLBLADDER CANCER?

The sources do not provide a specific classification system for gallbladder cancer.

What are the types of GALLBLADDER CANCER?

Most tumours found in gallbladder cancer are adenocarcinomas. Clinical features may depend on the tumour's location, such as in the fundus.

What is the epidemiology of GALLBLADDER CANCER?

Gallbladder cancer represents only 5% of all cancers found at autopsy. It typically peaks in age over 60 years and is more common in women, with a 4:1 ratio.

What is the etiology of GALLBLADDER CANCER?

The most common cause is cholelithiasis with chronic inflammation. Other etiological factors include porcelain gallbladder, liver fluke infection, choledocholithiasis, chronic cholecystitis, chronic cholangitis, and gallbladder hydrops.

What are the risk factors of GALLBLADDER CANCER?

The most common risk factor is cholelithiasis with chronic inflammation. Other risk factors include porcelain gallbladder, chronic cholecystitis, chronic cholangitis, and gallbladder polyps.

What is the pathophysiology of GALLBLADDER CANCER?

The sources do not contain information on the pathophysiology of gallbladder cancer.

What is the clinical presentation of GALLBLADDER CANCER?

In early stages, it is often asymptomatic or presents with symptoms of biliary colic or chronic cholecystitis. Advanced disease presents with non-specific symptoms such as weight loss, nausea, weakness, fatigue, an abdominal mass, and RUQ or epigastric pain. Jaundice and Courvoisier sign (enlarged, non-tender gallbladder with painless jaundice) can also be seen in advanced cases.

What are the signs of GALLBLADDER CANCER?

Signs of advanced disease include an abdominal mass, pain in the right upper quadrant (RUQ) or epigastric region, and jaundice. Courvoisier sign, which is an enlarged, non-tender gallbladder with painless jaundice, can also be a specific sign.

What are the symptoms of GALLBLADDER CANCER?

Early symptoms can include those of biliary colic or chronic cholecystitis. As the disease advances, non-specific symptoms like weight loss, nausea, weakness, fatigue, chronic epigastric pain, early satiety, and a sense of fullness are common.

What are the diagnostic methods of GALLBLADDER CANCER?

Diagnosis involves laboratory tests showing possible increased liver function tests, cholestatic parameters (ALP, GGT, bilirubin), and tumor markers like CA19-9, CEA, and AFP. Imaging methods include transabdominal ultrasound, MRCP (often for definitive diagnosis), endoscopic ultrasound, and abdominal MDCT for staging. Biopsy is generally unnecessary as immediate surgical exploration is often preferred.

What is the pharmacological treatment of GALLBLADDER CANCER?

For unresectable tumours, palliative chemotherapy may be used.

What is the surgical treatment of GALLBLADDER CANCER?

Surgical treatment typically involves a cholecystectomy combined with resection of adjacent liver parenchyma (segments IVb and V) and regional lymphadenectomy from the hepatoduodenal ligament. For non-resectable tumours associated with jaundice, endoscopic duodenobiliary drainage can be performed.

What is the prophylactic measures against GALLBLADDER CANCER?

The sources do not contain information on prophylactic measures against gallbladder cancer.

What are the complications of GALLBLADDER CANCER?

The sources do not specify complications arising from gallbladder cancer.

What are the contraindications of GALLBLADDER CANCER?

Contraindications for surgery include distant metastases, spread to adjacent organs, involvement of the hepatic artery or vein, and involvement of retropancreatic/paraceliac or porta hepatis lymph nodes. Jaundice is also considered a contraindication for surgical resection.

What are 3 main differential diagnoses of GALLBLADDER CANCER and how do we differentiate?

The sources do not contain information on the differential diagnoses of gallbladder cancer.

What is the definition of ANORECTAL FISTULAS?

Anorectal fistula is an abnormal connection between two areas, originating in the anal glands at the dentate line. It is a small tunnel that develops between the end of the bowel and the skin near the anus.

What is the classification of ANORECTAL FISTULAS?

Anorectal fistulas are classified as Inter-sphincteric, Trans-sphincteric, Supra-sphincteric, and Extra-sphincteric.

What are the types of ANORECTAL FISTULAS?

The types are Inter-sphincteric, Trans-sphincteric, Supra-sphincteric, and Extra-sphincteric. Inter-sphincteric is the most common at 70%, Trans-sphincteric is 25%, Supra-sphincteric is 5%, and Extra-sphincteric is the rarest type.

What is the etiology of ANORECTAL FISTULAS?

Anal fistula develops from infection of anal crypts gland.

What are the risk factors of ANORECTAL FISTULAS?

Risk factors include constipation, diarrhoea, IBD, being immunocompromised, or having a history of recent surgery or trauma.

What is the pathophysiology of ANORECTAL FISTULAS?

The initial infection occurs in the ducts of the anal glands, leading to abscess formation. If the abscess ruptures, a fistula is formed.

What is the clinical presentation of ANORECTAL FISTULAS?

Clinical presentation includes recurrent perianal drainage and pain when one of the tracts becomes occluded. Redness, swelling, and irritation in the perianal area may also be present.

What are the signs of ANORECTAL FISTULAS?

Signs include recurrent/persistent perianal drainage, pain when a tract is occluded, and redness, swelling, or irritation in the perianal area.

What are the symptoms of ANORECTAL FISTULAS?

Symptoms include recurrent/persistent perianal drainage and pain that occurs when one of the tracts becomes occluded.

What are the diagnostic methods of ANORECTAL FISTULAS?

Diagnosis involves a bidigital rectal exam and anoscopy. If the internal opening is not identified, probing the external opening or injecting methylene blue plus peroxide into the tract can be attempted. USG, CT, or MRI can be used for deeper abscesses.

What is the pharmacological treatment of ANORECTAL FISTULAS?

Antibiotics are indicated in some cases, particularly for those who are immunocompromised or have altered immunity.

What is the surgical treatment of ANORECTAL FISTULAS?

Treatment involves intraoperative unroofing of the entire fistula tract, which may or may not include the placement of a seton. A seton is a thin silicone string inserted to allow drainage, healing, and stimulate fibrosis. Surgical drainage of the abscess and a fistulostomy, which is an incision in the skin near the anus, are also treatments.

What is the definition of ANORECTAL ABSCESSES?

Anorectal abscess is formed due to the obstruction of anal crypts, resulting in bacterial overgrowth and abscess formation within the inter-sphincteric space.

What are the risk factors of ANORECTAL ABSCESSES?

Risk factors include constipation, diarrhoea, IBD, being immunocompromised, a history of recent surgery/trauma, colorectal carcinoma, or a previous anorectal abscess.

What is the pathophysiology of ANORECTAL ABSCESSES?

It involves the obstruction of anal crypts, which leads to bacterial overgrowth and subsequent abscess formation within the inter-sphincteric space.

What is the clinical presentation of ANORECTAL ABSCESSES?

Clinical presentation includes sudden onset rectal pain with fever, chills, and malaise. There is also tender perianal swelling, erythema, and warmth of the overlying skin.

What are the signs of ANORECTAL ABSCESSES?

Signs include tender perianal swelling, erythema, and warmth of the overlying skin. Fever and chills are also present.

What are the symptoms of ANORECTAL ABSCESSES?

Symptoms include sudden onset rectal pain, fever, chills, and malaise.

What are the diagnostic methods of ANORECTAL ABSCESSES?

Diagnosis is primarily clinical. A bidigital rectal exam and anoscopy can also be used, and USG, CT, or MRI are options for deeper abscesses.

What is the pharmacological treatment of ANORECTAL ABSCESSES?

Antibiotics may be indicated in certain cases, especially for immunocompromised patients or those with altered immunity.

What is the surgical treatment of ANORECTAL ABSCESSES?

The treatment for anorectal abscesses is surgical drainage.

What are the complications of ANORECTAL ABSCESSES?

Anorectal fistulas are typically chronic sequelae that result from anorectal abscesses.

What is the definition of PILONIDAL SINUS?

Pilonidal sinus is a cystic inflammatory process located at or near the cranial edge of the gluteal cleft. It is a cyst or abscess that often contains hair and skin debris, usually found near or on the cleft of the buttocks. A sinus tract or small channel may originate from the source of infection and open to the skin surface, allowing material from the cyst to drain.

What is the classification of PILONIDAL SINUS?

Pilonidal sinus can be classified as acute, presenting as an abscess or fluctuant mass, or chronic, presenting as a draining sinus with pain.

What are the types of PILONIDAL SINUS?

The types are acute, which presents as an abscess, and chronic, which presents as a draining sinus.

What is the epidemiology of PILONIDAL SINUS?

It is most common in young men. Clinical presentation typically occurs in individuals aged 15 to 35 years.

What is the etiology of PILONIDAL SINUS?

Etiology includes ingrown hair, excessive sitting, trauma, excessive sweating, and anaerobic bacteria.

What are the risk factors of PILONIDAL SINUS?

Risk factors include ingrown hair, excessive sitting, trauma, and excessive sweating.

What is the clinical presentation of PILONIDAL SINUS?

Acute presentation is an abscess (fluctuant mass), while chronic presentation is a draining sinus with pain at the top of the gluteal cleft. It is typically very painful and usually located in the coccyx, though rarely it may affect the navel, armpit, or genital region. It can also be asymptomatic.

What are the signs of PILONIDAL SINUS?

Signs include a fluctuant mass in acute cases (abscess) or a draining sinus in chronic cases.

What are the symptoms of PILONIDAL SINUS?

Symptoms include pain at the top of the gluteal cleft in chronic cases, and it is generally described as very painful.

What is the pharmacological treatment of PILONIDAL SINUS?

Pharmacological treatments include antibiotics, hot compresses, and creams.

What is the surgical treatment of PILONIDAL SINUS?

Surgical treatment involves incision and drainage under local anaesthesia with removal of involved hairs. Surgical excision is also an option, which requires post-surgical wound packing replaced twice daily for 4-8 weeks. Sometimes, surgical marsupialisation or reconstructive flap techniques, such as a "cleft lift" procedure typically performed under general anaesthesia, are used

What is the definition of ACUTE APPENDICITIS IN CHILDHOOD?

Acute appendicitis in childhood accounts for more than 90% of acute abdominal problems and emergencies.

What is the epidemiology of ACUTE APPENDICITIS IN CHILDHOOD?

It accounts for over 90% of acute abdominal problems and emergencies in children.

What is the clinical presentation of ACUTE APPENDICITIS IN CHILDHOOD?

It usually presents with diarrhoea, fever, vomiting, and pain in the right lower quadrant. Other features include guarding, McBurney’s sign, and migration of periumbilical pain to the right lower quadrant.

What are the signs of ACUTE APPENDICITIS IN CHILDHOOD?

Reliable signs include abdominal tenderness and pain with walking, jumping, or coughing. Guarding and McBurney's sign are also present.

What are the symptoms of ACUTE APPENDICITIS IN CHILDHOOD?

Common symptoms are diarrhoea, fever, and vomiting. The most reliable symptoms are emesis and duration of pain.

What are the diagnostic methods of ACUTE APPENDICITIS IN CHILDHOOD?

Ultrasound (USG) is considered the diagnostic procedure of choice.

What is the surgical treatment of ACUTE APPENDICITIS IN CHILDHOOD?

The treatment for acute appendicitis in childhood is appendectomy.