1

Y.B

GERD








Crohn's

Volvulus

Ulcerative colitis

-

2-5
6-7
8-9
10-13
14-15
16-17
18
19-20
21-23
24-27
28-30
31
32-33
34-36
37-38
39-40
41
42-43
44
45-48
49-50
51-53

Y.B

:
.
. .
.
:
" . 2 ) (
, :
" ;ANS-
.1
, , .
, ) (.
.

:
) Foregut - 2 ,
, ( .
) Midgut - 2
( ) (.
) Hindgut - (
-.
"
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.
; , , . "
" )
(; " , .

.

.
) (Subphrenic .
) (Renal colic .
.
:
.1:
:
.1

Y.B

Onset : ) (
) .(AAA
) ( .
) ( Colic syndromes (B.colic, -
,Ureteral colic (; ,
; .
) (
; ) , (
) , (.
: ;
) ,
( . ,Biliary colic .
" )
(.
: "
) RUQ ( .
.
:
" .
"
.
:

GE-
.
.
, .
.
:
.2
PVD -
AAA .
.
DM IHD PVD .MI-
RUQ
.

,PID , ) (,
.
,
.
:
.3
NSAIDS .PUD

.
, ) -PMC
(.
.2 :
:
.1

Y.B

. Colic
. )" ,
( . .
:
.2
. ,
; ) (39 , .
" , .
:
.3
, , .
;
Ileus .
) ( .
,
) ( . .
.Guarding -
Guarding - .
.

.
) (.
PR :
.
) , ( PR .
.
.
:
.RUQ-

, .
) US (probe -
.
Obturator sign ,
.
)
(.
Iliopsoas sign - .
, -
. .
Rovsing sign . RLQ
,LLQ- .RLQ-
.3 :
.
.1
) ( .
.
) ( .

Y.B

.
.2
.
.
) 2(ALK ,
.3
PHOS .
) (3 Acute RUQ pain -
.CBD ,"
.ALK P -
) 1000(
.
) (
.4
.
.
, .
" .
.
.5
B-HCG .
.6
.4 :

:
.
.1
.
,
.
20% .
, - ,
:
, - , .
) Sentinel loop . (
) ( Ileus
.
90%-
, 15%- .
. .AAA
) Phleboliths (.
/ ,
.
:
.2
US RUQ ;
.95%
3" , . CBD-
) 8" ( .
.
US .
US RLQ
.

Y.B

Contrast studies ,
.3
. ,
" . , Ileus
Adynamic .
CT .
.4
IV- C/I. CT
. ,:
.

.
) (CD .
-.
.
:
.5
.
RBC WBC / .
99 .
,:
.6
.
.
.5 :
: , , , .
.1
- ; ; ,
) ," '(.
" ) ,,
.2
(; .
: ; ;
.3
; ; .AAA
) ,IBD ,(,
.4
, ) (.
, , ) ,IBD
.5
,(.
:
;PID :; .
.6
: ; .UTI
.7
) ( ;MI; GE :; .DKA
.8

;
. :
.1 )(
)" ( /;
.
.2 .
) ( , )( , , ,
, .

Y.B

.3 ) ;
(,
) PVD , (.
.4 ,"
.
.
:
4 :
Clean .1 . , .
, , , ;
. ,
.
.2.1%
Clean Contaminated .2 ) ,-,
,(GI , . ,
, . Minor break .
.3.3%
Contaminated .3 , ;
; ; Major break
. , .
.6.4%
Dirty and Infected .4 ; ;
; ; ;
. .
.7.1%
:
.1 .
.2 30 .
.3 .
.4 .
.5 " : ; ;
" .
30 , , Implant .
:
.1 " .
.2 .
.3 .
.4 .

:
.1 , , , ,,
, . ) ( .

Y.B

)"
( . ) ( .
.2" , "
) , ( . Clean-
contaminated " ) (
. ,3-4
;
.Class 2 -
, " )
.(Cefazolin " )
.(Tienam "
IV .
,
.
- )
, ( . , '
.
SBE 2
. )
(.
.3 80% ;
, "
. "
.3-4L-
;
.45cc "
.
" "
)' (IV " ) +
.(PO " .
.

Y.B

) (
. ,
, , , .
) (MAPCO-
) SVR). MAP CO- .SVR- CO-
, Preload, Afterload -
MAP Preload, Afterload ,.
" - , ,,
Preload, Afterload ,.
:

. :
.1 )" (20%"
)= ( , ; " 3 "
. , , ,
JVP.
.2 CO- ) ,AMI
, , , '( .
, , , JVP-.
.3 ) (Obstructive shock CO
. ,PE, Tension PneumothoraxJVP .
" .
Distributive shock .4 " ,
SVR , CO-;
) CO ( . ,
,SIRS" " .
.5
- .
- ) (,
, JVP ,.
:
.
, CO-
:
SaO2 .1 , Airway " .
92% .
.2 %7gr ,
) %7-9gr MI ( .

10

Y.B

; .
, .
CO .3" .
" 25% ,CO- AF 3rd AVB CO-
. ;
) (140 ,Preload - .CO-
, )
( ) .(VT-
,
ml/Kg 10-20 )(
) .(14-16G .Central vein
.
)

, (.
.4 : " .
1ml/Kg/hr"
2L/m^2 .
.
.
)( ;
.
,PH , .Base deficit
PH " ) PH
(; BE . ,
.

. 4 )
(:
- 1 750" .
.1
- ,100-" , ,
; . .
- 2 1500" .
.2
, , .PP" .
- 3 2 40% .
.3
, , " .
.
- 4" ,35
.4
,140 , .
:
.
.1
:ABC
.2
.1 .
.2 Airway .
.3 ) , '(.

11

Y.B

:
.3
2 ; "
Permissive Hypotension - 250"
.80 ,
) , , (.
) .(-O
)( ;
. -
, ) .(DIC
.
) (.
.4
.
.5
*** CVP ) (5-10 .
, )
( ," PEEP , CVP .
" , , '.
Fluid challenge 250-500" , .CVP
CVP . CVP 22-
, , .

.1 ,
:ABCDE
Airway , "
.1
.
Breathing ,
.2
. 100%
.
:
.Tension Pneumothorax .Pneumothorax/Hemothorax .Open Pneumothorax .Flail chest .Tracheobronchial disruption Circulation ,
.3
.
. ," ,
. )" / (.
Disability
.4
.
.
Exposure ,
.5
. .

12

Y.B

.2 :
" , , " , .
.1
.
.2
, , ) (DIC- ) PH(.

.3
. PH - 7.4 0.5-1
.ml/h/Kg
:
.4
, " ) ( .

.
FAST . CT . .3 ;
: , ,,
, , , , , . ,
/ . ,
.
.4 ,

.

- , ,
, , , . , ,
; .
2 ; 2
. 30% .
. ,
CT-
, , . :
,
:
Tension Pneumothorax .1
) ,
( . , ,
.

13

Y.B

, , ,
) ( ,
.
: -
.
" , 14G 23-
) (
) (.
" )( 4-5
) ( . "
.
- . "
.CXR
, ,
- ; " ".
Simple Pneumothorax/Hemothorax .2
. .
.
) - 1500
"( - ;
.
.
- .
Open Pneumothorax .3 , .
)"
( , .
- Flail chest .4 ) 3 ( , )
2 ( - "" ,
. .
.
Tracheobronchial disruption .5
.
, . "
. " .
.6 . -
; )
( . )
(.
.7 , , .
. ;
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) ( . ) ( .
.

, :
.1 - )
( . - " , .

14

Y.B

.2 - .
- TEE .
- 24
" .
.3 - ;
, - ) ,'( -
" ,
. .
.4 - , , , - .
- ; 250"
" - 1500 . .
-
.
.5 - CT
.
) (.

.
:
, ' .
, ;
.
, ) ( :
.1 - )
( . , ," ,
. )
( .
, .
.2 ) ( -
. ,
.
, , " ) '(.
, ) ( ,
.
, Zones -
-:
Zone1 -
.1
) , ,( . Zone1 -
) CT- ( -
, '.
- Zone2 . -
.2
-
.
- Zone3 .
.3
) Packing ( .
.

15

Y.B

, .
) (;
. , ;
PR )
(.
,
; :
- CT ) (
.1
. / CT
.
CT -
. Blush
.
- FAST . ,
.2
FAST. FAST- .
,FAST - ) DPL- ( CT -
) ( .CT -
angio .Blush
- (DPL (Diagnostic peritoneal lavage
.3
, , -
, ,
. .US -
,
.4
.
. , )CT, FAST,
(DPL .
:
" - ) - , (.
.1
- ,,IVP ,
.2
) ( , ) (.
:
-" . , ,
. -
.
- -.
) , FAST, DPL
CT (.
:
.1 - ) ( ,
.
.2 - .
.3 - .
, . -

16

Y.B

, -
) -
( . .

:
Coffee ground .1 , )
( . ,
) , ,UTI , (.
.2 )(; .
.3 ; Coffee ground
) .(Treitz ligament -
Cherry red .4 , . ,
.
.5 ) ( .
:
.1 . .GI
,Losec IV" ,
, . , .
.2 " ) , -
( ." .mmHg 25-30 -
.3 .
.4 ;GE Junction - ,
) "( . 10% .
.
.5 ) Delafois - ;
; " (;
; .
:
.1 - , .
. " .
.2 .
.3.

17

Y.B

.4 ) (
) 25% ( . ,
) 25% 4-(.
) AV Malformation .5( .
. 70 .CRF
.6 )/( ,Meckel's : ),
,( , , .IBD ,

:
.1 , , ,
, , .
;
. .
-
)" (.
.2 :
) Meckel's IBD
.1
, (.

.2
, , , , .
)
(.
,NSAIDS , ) (.
.3
.
.4
CRC .
.5
.3 ) PR ( , , /"
.
.4 ) (Baseline ) ( , ,
) ( ,.
.5 /:
CXR .
.1
) /(
.2
.
, '.
- 6 .
" .

18

Y.B

.
.3
.
CT , .
.4
AVM
.5
. - )
( SMA.IMA-
5" .
;50-70%- .
RBC ;
.6
, ) (
. .
.6 :
Blackmore tube .
.1
12-.
, 200" .
) ( )
mmHc 10-15 (.
.TIPS
.2
.
.3
. .

GERD
GERD
. ,
. "
) 7% , 33%- ( . ,
) .(Hiatal hernia
.
:
GER .-
60% , ) LES-
( . GERD-
, , ,
.LES-
:
- " .
, .

19

Y.B

20%- , , " .
/ .
:
.1 Upper GI 40%-
; ) ,(.
.
.2 .
.3 )
.(LES LES-
, .Diffused esophageal spasm -
Ph testing .4 Gold standard .GERD
.90%
:
.1 :
, , ,,
.1
. .
),CCB ,
(.
.
.2
:
.Antacids
.H2
PPI'S .
) ( "
LES- .
" Suturing .
.3
.LES-

.2 : , LES
, .
- Nissen funduplication 360
" , . -
90% 10 . "
.

, " . ,
180- 240 , 270
.
Nissen ,Transthoracic
.

20

Y.B

Barrett's Esophagus
. -
GER . ,
) " ( .
.
10-15% .
:
.GER 50%-
; 75%- 25%- . :
.1 .
; 50%- ,,
. 30-50%- .
.2 - ,
High grade dysplasia . .Car in situ -
.3 50-
100 .
:
," ) -
80% ( .
.
:
,
. GERD-
, ,
.
, GERD
.
" . " "
) (.
Low grade dysplasia ) (
3-6; GER-
.
High grade dysplasia ,CIS- -
.Esophagectomy
, .

21

Y.B

1% " , 1.8%-
. :
- SCC .1 SCC- , , , ,
, . , ,,
.
SCC .
.
.2 - GERD , .
50%- .
, .
.3 ;Small cell carcinoma; ;
.
:
.GER
, .
, , ,
. 50%-
, .
:
Staging - .TNM ,Staging - CT,
PET-CT) EUS - (.
:
.1 ,
. 5- ) 20-30% Stage -
(.
Esophagectomy Transthoracic Transhiatal .En bloc
, '' .
.2 -' .
.
.3 SCC
. 5 .5-10% 80%-
" .
, ) FU-5 C
( .
.4 . '
,SCC .
.

.

22

Y.B

, PPI
H2 . , ,
) , , (
) ( .
:
.
,
.
DD- , , .
"
; .
,
.
:
.1 , .10%
70%- .
. : ,
, ) 6 RBC( ,
.
" ;Gastroduadenal -
Duadenectomy Vagotomy.
Wedge resection ) Vagotomy
II III - (.
.2 " )
, ( .
. , ,
. 80-85%- .
24-,
, ,
. "
.
" Omental patching and
peritoneal debridement HP ; HP
,
) .(PCV = Parietal cell vagotomy " Wedge

23

Y.B

resection ; Vagotomy PCV

.II/III
Partial gastrectomy Antrectomy .
.3
. ,
, .
, , IV - .
.
. 3-4 ,
75%
, .PCV with Gastrojejunostomy "
80%- , 40%- 3
.

:
;PUD
) (
) , .(H. pylori -
RUQ .
H. pylori 90% 75%- .
, .
, ,
) 2 3- (
.ZES

24

Y.B

.
5 .15%
,HP- ,Chronic atrophic gastritis, Pernicious anemia ,
, ,Menetrier . ,CRC
. 12%
.
:
, ,
, , , Upper GI
. ,
, , , , ,
' ,Blumer shelf , )(.
:Staging -
" "
. "
) , ,Pernicious anemia
(.

25

Y.B

Staging -
CXR- .
:
CT .1 , .
) Down staging(

Up-staging.
EUS .2 CT- ,
. -
Early gastric cancer 5% ;
,
) (.
.3 ,Staging - Staging -
58%- )" Upstaging .(Downstaging -
, , 40%-
' ;
, .
:
.1
,
. ,
.
)(
. 5-7" ,
. En bloc , , ,
;
".
D1
; D2 Left gastric, Hepatic, Splenic.Celiac -
D3 D4- , .
, " ) Roux-en-Y ''
Y ''( ) Billroth II ''
( . ,Billroth I
.
,
.
, Gastrojejunostomy
)
(.
.2 '
.
.3 -'
. ,
) ( ,
. -
' , .

26

Y.B

.4 ) (FU-5
, -'
.
Hyperthermic Intraperitoneal Chemoperfusion with mitomycin C .5
,
.
(Primary Gastric Lymphoma (PGL
5%- ,
." .B cell non hodgkin HP-
,PGL ,MALT HP
.
50- ,
) ,(68% ) (28% ) (28% . PGL-
.
:Staging -
. ,
.HSM
;
80% .
.HP PGL .
CT .
.
Staging - " ,CBC, LDH , CT
. , EUS
.Staging -
:
PGL- ,
. ,
:
.1 IE IIE -
) , , , ( .
Staging , .Grading -
'.
.2 III IV-
' .
.3 '
.

Post gastrectomy syndromes

27

Y.B

" .
. 20%-
, , ,
, , .
:
Dumping syndrome .1 ) ,
( .
.Billroth II :
Early dumping 30 , ,
, - ) , ,(.
.
Late dumping - 1-4
.
.
,
, 30 , .
, .
- Roux-en-Y - .Billroth I -
Alkaline reflux gastritis" Billroth II
.2
.
, . .
. Urso
. ,
" Roux-en-Y .
Roux Stasis Syndrome .3 30% Roux-en-
.Y , , " .
.
, .
Loop syndromes Afferent - Efferent
.4
.Billroth II .
.5 Vagotomy 20% Truncal vagotomy
.
. ) (
. " ,
.
.6 30% .
, ,B12 , D ,
, . "
.

28

Y.B

) (Cholelithiasis 60
25% 12%- . , -
.50%
3- : , ,
. 1-2%
.Biliary colic
. 3%-
, ,,
.Ileus -
3-:
.1 85% . ,
) ,(2:1 .
.OC-
.2 ) 15% (:
- ,- -
.1
. , .Ileal resection -
)
.2
( . -
-.

,
. " ) ( US
. .
, :
.1 ) Porcelain gallbladder
(
.
- , 3"
1-".
.2 ,
.
.3 .
.
.4 .
.5 .
.6 .
Biliary colic

29

Y.B

,PUD, Renal colic, GER, IBS ,

- .
:
Biliary colic ;
:
.1 - 30 ,
.
.2 - .RUQ -
.3 .
,
.
.4 .
.
, ,LUQ-
.
.RUQ- .
:
US ."
.
) .(CBD-
. -
- . - ,
) ,
( , .
5%-
, .Acute Calculus Cholecystitis
.
; ,
. ,Biliary colic
.
,
,Empyema, Gangrene .
:
Biliary colic . RUQ-
. ,
RUQ- .
, . .
, .
, -
/CBD/ .Common hepatic ducts
Hartman's pouch - ;CBD-
.Mirizzi syndrome

30

Y.B

)" (12k-15k
. ,Gangrene
) .(20k
, ,Alk phos , , .
:
, :
US .1 ) 88%
.(80% , ,
.
Radionuclide cholescintigraphy .2 .US
4 ) ( ,
.
CT .3 . ,
.US-
, , )
(.
:
, "
) ( 3
, ' + 3' , ) (
'.

, ,
. ,
" , )( ) (.
, .
. " ,
.
48 )
( . 5%
. ) 3-
( , )
(.
Tube cholecystostomy
. ,
.
. ,
)
(.
Choledocholithiasis
" Cystic duct -.Common duct -
, 3-10".%
Biliary colic . , .

31

Y.B

US " .
50%-.
" ERCP .PTC
:
ERCP Sphincterotomy .
,1%- ) 5-10% (.
.
Gallstone Ileus
" .
, .Ileocecal valve -
) (.
" .Enterotomy -
. ,
, .
Biliary pancreatitis
" -
. ERCP ;
,ERCP- .
,
.
C/I ) ( .
.

Acute Cholangitis
. "
.
,
, - ,
. ERCP ) (
) " (.
:

. 90% . ,
, , RUQ 50--
.70%

32

Y.B

) Reynold's ,
( 10% , ,
.
, ,ALKP ,.
US . CT-
, " ERCP
;PTC ;
, , .
:
" IV ,E.coli :,
.Bacteroides.F -
,
) ERCP ( . ,
) T tube.(CBD-
.
, .

.

33

Y.B

,
.
, ,
.
:
.1 40% -.
.2 40% -.
.3 ) (5% : , . : ,,
, ,.
.4 ).ERCP (5%
.5 : , ,,
, ) , , ,B, EBV, CMV,
,HAV, HBV , ( , , , .
:
" .
" .
" . , ,
, " .
," ,,
. ) (Pancreatic arthritis
.
:
Necrotizing pancreatitis .1 -
. .10-20%-
.
Infected pancreatic necrosis .2 5-10%- .
80%- .
) ,E.coli , , , '( .
" , .
.Acute pseudocyst .3
:
. 2-12
2-5 . 10-
, - .
. .
" , ,,
, ,CBD , , ,
,Afferent loop, DKA , , , ,
,/ .-
.
) Serum lipase ,
3-5( , , .

34

Y.B

:
:
CT .1 US- " . CT-
90% 100% .
" . CT
, , , ,
.
IV .
.2 ) 15
( , , ,Sentinel loop sign ,
.
US .3 62-95% .95%-
40% , " .
ERCP .4 . :

.1
.

.2
24 .
40
.3
, .
40
.4
.
PTC CBD ERCP
.5
, .
:
" " .Ranson 5
, 6- 48:
.1:
.55
.1
.WBC>16k
.2
<.200
.3
.LDH>350
.4
.AST>250
.5
.2 48:
.10%
.1
Urea-nitrogen 5".%
.2
>.8
.3
PO2 > 60".
.4
.Base deficit > 4mEq/L
.5
< 6.
.6
Ranson
0-2
3-4
5-6
<6

Mortality
0%
15%
50%
70-90%

35

Y.B

:
.1 :

.1
. ,TPN
''.
. .
.2
.CVP .
" .
.3
12 3-
.4
- . ,
. 50% .
.
.5
" .
.6
"
.7
, CT- .
,
.8
.
.2 :

.1
,
.
,
.2
, .

.3
, .
.

.4
"
) (.

36

Y.B

.
, 5- .5%-
, , , ,
, .
80%- .Ductal cell adenocarcinoma
70% 20% , 10%-.
:
; -
. 80% ,
.
70%- . 50
. .
, , 30-40%-
.
10%- .
.Courvoisier
Sister Mary Joseph .
: ALKP , , , )CA19-
.(9
:
CT- 2"; - ,
/ .
ERCP . US .CT MRI- "
.CT
EUS , .
:
.6 : , SMA, SMV-
.Portal vein confluence )(
; ,
/.

37

Y.B

(Pancreaticoduadenectomy (Whipple En bloc

CBD , , ,'' .
5%- 30 , .
,
.
.7 : ) (,
; " PTD "
. " ''
.PEG
.8 : ' .
.FU-5
:
. 5- 5% ) 20%
( . ,
, .40%
3-10 ,
6.

Pancreatic Pseudocyst
.
, .
.
, ;
" ) .(Acute pseudocyst ,
- .
:
.
, , , , .
.
: , .80%-
:
.1 5-20%- .
.2 .7%
(Splenic (45%), Gastroduadenal (18%Pancreaticoduadenal -
.((18% .
.3 , , .
.4 3%- . .

38

Y.B

:
CT , 2 .US- CT
:
.1 4-" " .
.2 " .
.3 .
:
, , .
6-" 6- .
6 , .
.1 ,
CT US .
6" .
.2
.
. 3-4.
.3
. ) Whipple ( Distal
pancreatectomy .
.4 -
. .
.10%

True pancreatic cysts

,
:
Serous cystadenoma .1" .
Mucinous cystadenoma .2" .
.3 =) Intraductal papillary mucinous tumor
(Cystadenocarcinoma, Acinar cell cystadenocarcinoma, Cystic ,
,choriocarcinoma, Cystic teratoma.Angiomatous neoplasms -
:
Carcinoembryonic antigen .1
.
Ca 125 .2 ; .
Ca 19-9 .3 .
Ca 72-4 .4 .
; .
.5 .

39

Y.B

.6 - .
.7 ;
.
.8 ,
.
Percutaneous wall biopsy .9
, ) (
) (.
:
.1 .
.2 .
.3
.
.4 .
:
. .
. '.
60%
5-.

.:
.1 , 50-70%
. -
. . 5%
.
.2 ) , , , ,incisional ,(
,
.
.3 , -
, .

40

Y.B

.4 , , ,
meckels
.
.5 - ,
. .
.6 , ) ( ,
.
.7 :
Gallstone ileus
.1
; /
- , .
, , , .
.2
.
.3
Meconium ileus CF- ,
.4
.
:
.1 " .
, ,
:
,
.1
.
) (Strangulated obstruction
.2
, . " "
.
- Paralytic Ileus .
.2
, , , ,
, .
:
.1 .
, , , .
.2 .
.3 , .
.4 .
, .
.5 , ,
) (Third spacing . , ,,
.
.6 .Strangulated bowel -

:
.1 ,"
.

41

Y.B

.2 , .
) ( . ,
. Guarding ,
.Strangulation - PR
.
:
, .,
,
, , , .,
, . ,
.Strangulation
:
.1" ) ( ) 3"(,
3 - , .
, .Closed-loop obstructions
Strangulated obstruction - ,Thumbprinting
- .
Lateral decubitus
.
RLQ- .Gallstone ileus -
Paralytic Ileus , .
.2 )
( . .
.
CT .3/ .
/ ) ,
'( CT . .Strangulated bowel
:
Mesenteric vascular ischemia .1 , .

. .
Colonic obstruction .2
- . .
Paralytic ileus .3 , ) GI-
(Paralytic ileus - .
Primary hypomotility disorders .4 .
) ( .
.Paralytic ileus ) ( .

42

Y.B

:
.1
.
.0.5ml/Kg/h ,
. 4-6
," . ,
48 , .
,
. , / .
.
- ,
, ,
, .
.2 -
Strangulation . -
24-36 , Gangrenous bowel - .30% ,
, :
NS
.1
) .(0.5ml/Kg/h ,
CVP- . "
. , .IV ABX
" ,
.2
. .
, .
, , )(
.
-" , . ,
24-48 .
, .
Ileus - , .
:
Non strangulating .2%
8% 36
; 30%- 36-.

43

Y.B

Crohn's
GI- .
,
.
15 30 55 - .70 ,
, .
, .
CD ;UC 2-
:
)75%
.1
(.
15-30%- , . 30%
40-60% .
.
1-7%- , 3%- - .
Skip lesions 15%-.
, ,
.2
" " .
" " , , ;Cobblestoning -
.
CD ;
.3
, , , .
- Sinus tracts - Crypt abscesses -
.
50%- ,
25%-.
:
.1 90%- " .
, . ,
.
.
.2 " , , " , " ,
. .
" , .
.3 , , .
CD .
.4 , .

44

Y.B

.5 - .
, , ,
. -
.CD-
.6 - ) Iritis ,
( , ) , ,-( ,
)( , ) PSC (.
:
, , , , ,
-/ ) Toxic colitis , ( ,
.
:
. .
. , /B12/
. , ESR.
:
,
:
.1 .CD Single - Double contrast
) , (.
.
.2 Terminal ileum .
, Cobblestoning - .
.CD- )
10 ;
(.
CT .3 , , CT .
.
.4 .
:CD
UC .1 CD-" ,"
. CD UC- - , ,
, , Rectal sparing ,
. 2 , Indeterminate
.colitis
.2 RLQ- CD .
.3 , ,' , ;CD
" .
.4 , .
TB .5 " .
.6 ,.PMC, IBS ,
:CD-

45

Y.B

.1 CD , ,
. ,
.
.
, , , , ,,
B12, D .K-
)
( , .MCFA .TPN-
.2 .
.5ASA- / Perianal/ .
,
. .Infliximab -
,
) 3-6( MP-6--
.Steroid sparing agent
.3 , ,
, ) ( , ) (,
) ( , , )( .80%-
.

; 2" .
, " .Stricturoplasty
, ,Enterocutaneous )
( . .5%-
, 50%- 5 , 75%- 15.

. 10%-
;
20- . 2 ,25"
.
, ;
- 60%- ,
. , Fecalith - ) .(35%
;
, .
, .
:

) (; ) (90%
) .(38.5- ,
" ) .(70%10%- . ,
;RLQ- ,
. ,
." .

46

Y.B

,Retrocecal
) (;
, , .
, Acute GE , ,
. .PR
.
:
;
.
.1 :
, Rovsing .
.1
. .
Psoas - .
Obturator.
PR .
.2
) Retrocecal .(Pelvic
, .
.3
RLQ- Periappendicular abscess .Phlegmon
.4
.2:
.
.1
.
40% . -,
.2
.
,
.3
/.
.3 :
US ,
.1
. 6" ,
.
.
CT
.2
.US- CT
, - , ,
.RLQ-
CT Periappendicular abscess.Phlegmon -
:
.1 :GIT
GE ,
.1
, , ,/ . .
" ) (20
.2
RLQ- .
, .
.URTI
Meckel diverticulum
.3
, .
,Perforated PUD ,.
.4
.Typhlitis
.5
.2 , .

47
.3

Y.B

,PID , .Torsion ,

:
.1 , , );
.(39
.2 "
. ," ' .
, 24-.
" 3-5.
.3 , .
" .
, .
5-20%- , )(
,
) , , ,IBD , (;
.
.4 Appendiceal abscess .

, " ,CT/US
6-12 . 80%-.
, 60%
.
; ,
" 5- .
:
.1 ." 12- ,
50%- 10 .50
, , .
, , IV " .
.2 5%- 3%-
. , .Packing -
, .IV ABX
.3 - .
CT ) US (.
.4 ) Pyelophlebitis
.E.coli), Enterocutaneous fistulas, Small bowel obstruction

Volvulus
; 10%-
".
Sigmoid volvulus

48

Y.B

80-90%- ,
.
.
:
, , ."
U ,
.RUQ ,
" " - ) (.
:
, Rectal tube
. ,
.
.
, ),
' (.
,
, - .Loop ileostomy
40%- Rectal -
.tube
, ,
.
Cecal volvulus
Sigmoid volvulus -
- , LUQ
.
:
, , .
.LUQ
.
:
.Right hemicolectomy - .Ileocolostomy
) Cecopexy .(Retroperitoneal flap -
Transverse volvulus
.Sigmoid volvulus - " )
(U .
, " .

49

Y.B

-
. -
. ,
.
- , ) 30 ,(2%-
) 75% .(80
:
.1 )(
, .
) LLQ - , , (,
, , .
, LLQ .
.
: " CT CBC. CT- ,
;CT .

.
: :

) + +'( .
" , ,IV
;IV
48
.
.
.
4-6 ,
,IBD , .
)
, ( /
2-3 , .one-stage
30% 50%-
. , 4-6

.
" .

. ,
.anterior peritoneal reflection
" .
.2
. ;guarding
. )two-stage
(procedure . , ,"

50

Y.B

) 2-4( .
) 20-30% , ,( .2-3%

) (
, loop
.ileostomy
.3 " .CT- ;
, ,IV
2 3 .one stage -
.
.4 , , ,
. enterovesical
. - - "
. " .
- ,
.
- UTI "
fecaluria .pneumaturia " CT
.

51

Y.B

Ulcerative colitis
UC ,
.
.
, ,
. .
, ; ,
.Crypt abscesses -
) ( ,
. ) -
.(CD
.CD- ,CD ,UC-
.
:UC-
.1 -
.
.2
. 1% - , 10 .
7-10 ," 1-2 10",
. .
.3 .
Acute sever fulminate colitis .4 ,k16 ,
. " , ,
, . ,
.
"
. , .
; ,
.
" ,
. :

52

Y.B

(Restorative proctocolectomy (ileal pauch anal anastomosis .1

. .Anal transition zone
Ileal pauch 15" J .
"
.- Protective ileostomy 3 ,
.
: ) 5-7 ( , ),(20%
' ) (10%' ) (28%
" . '
4-5 .
.
Total proctocolectomy and end ileostomy .2
, -
. Brook
) ( Kock pauch .
6-8 ; , .
continence
.

.
10-15% .CRC - 85% -
;CRC - ,
CRC 3-9 . CRC-
) K-ras, DCC, P-
.(53
;CRC-
, . .

.
-:
UC - 1% 10% - 20
; 30% .
) 35% III (IV . CD
7% - 20 .
. SCC
.
:

53

Y.B

. ACS - PR
.40
50 10 ) (.
;
.7 UC 10 -;
CD ; /;
FAP .HNPCC
.

,
, . .5%
.50
:
- .
" .
" .
, . 50%
,
.CRC

, . ,
, .
.
" ,
.
" :
.1 - - ,
.
.2 - ,,
.
.
.3 - , ;
- .
:
, ,
) ,5%30%-
( . .

.
Staging CXR CT - CT .
, , , CEA .
.CRC ) staging -
.(0-5
:

54

Y.B

.1 E.coli ,Bacteroides
.
. .
IV 30% - .10% -
,
.
.2 .
, En bloc
, , , .
2" ) 5" poorly
.(differentiated
" .
. :
- Right hemicolectomy ,
.1
. 4-6 -"
-
.Middle colic artery .
- Extended right hemicolectomy .
.2
Rt + middle colic artery -
.
- Left hemicolectomy .
.3
.
- Sigmoidectomy .
.4
-
.IMA
- Total/subtotal colectomy
.5
.
. ,
HNPCC .
) (
. , .
) (
)
(.
, : ,
, -
,Protective Ileostomy - Ileosigmoidostomy Colostomy
.
- ,
.
.3 ' Stage
.III Stage II '
.
.4 ,
90% . 3

55

Y.B

. CEA CT,
CXR PET .
Staging:
Staging - .TNM
Stage I 5 - .90%
Stage II .60-80%
Stage III 50% 5 -.
Stage VI 5 - .5% -
,Poor differentiation :
, , ,
CEA -.

:
) (;

. , .
:
, , ,
.
TRUS .
.Staging- T1 -; 2T
; 3T 4T
TRUS . NPV-
.90%
CT MRI , .TRUS -
.
.
.
) ( CXR, CT .CEA -
.PET -
:

, , .
, .
.1 .
.Loop ileostomy -
.
.
2" .
, , :
Resection (Miles) Abdominoperineal
.1
2" ) (
.

56

Y.B

Low anterior resection

.2
) ( . Total Mesorectal
- Excision .
,
." Protective ileostomy
; )
PR (.
:
50%.
.1
20% - ," 4-7
.2
. : , , ,
.CT-"
IV ,
.
Massive presacral venous bleeding .
.3
" .Packing
.2 ' 5 -
50% :20-30%
Stage
.1
. " ,
.

.
-'
.2
, III-
./Stage II

57

Y.B

-
)(
" .
.
.
.
; . -
. - , '.
- " ) (.
, - Skin tag
.
) (;
.
)
2(; .
- . )
- ( .
.
- 3-:
.1 "
; ) - Nifedipine"
( .
. . " 50- . - .
.2 - 6;
.80-85% .
.3 -
. Midline - " "
. , ,
- " .
) ( .
. -
; 50%- .
.
- -" .

58

Y.B

. ,
, , -
) ( .
)
( - ,
2
) ( .
- .
1 - ;4 1 . 2
. - 3
. - 4 , .
.
- .
- . -
. 2-3 . .
- .
.

) ,
( ) (
) - -
( . .
- 3- -
. .LIGASURE -
.
- PPH
) ( -
) ( -
, - .
)" (
" - ;HAL .
HAL- PPH- ; .
.

- . ,
- .
. -
. :
.1 - .
.2 - - 10%-;
.

59

Y.B

.3 - ) ( -
,Levator ani
Ischemic necrotizing fasciitis )50%
(.
) Extra glandular fistula .4 ( 2-5%;
, IBD ;
.
- , ;
) (;
- " ,
) ( . .
) ,(TSF
- - .
, .
) ( ) (.
CD -
.
- ) (.
. -
.
)
( . . -
.
- . .
.

.
) ( , ) (
) (.
,Ductal carcinoma
80% . :
(Fibrocystic breast change (FBC .1 ,
, , .
10 , )
( . )(.
Breast cysts .2 , .
.
US-
. ,
.

60

Y.B

Fibroadenoma .3 .30
. , . US-
. 2-" .
:
" , ,
, .
:
.1 / , ,
, , .
, ,
OCP - ,HRT-
.
.2 ,"
. , , ) (,
.
. . ,
-.
.3 :
.
.1
) 40 25 .(BRCA
, . Radial
scar, Fat necrosis .
Spikes ,
, .
US /US .
.2
.
US ,90%
, .
) MRI(.
.3
.4 :
FNA .90% Grade
.1
. ,
.
Core biopsy Tru-cut .
.2
, ,Grade , .
.
Excisional biopsy; .
.3
Incisional biopsy .
.4
, .
:Staging :TNM
.1 :T
- (Tis (In situ ;
.1
.
- T1 2" . ) a - 0.5"() b , 1"( c -
.2
) 2"(.
- T2 2- 5".
.3
- T3 5".
.4

61

Y.B

- T4 - , , Inflammatory
.5
- carcinoma
. - 30%- .
.2 :N
- N1 .
.1
- N2 .
.2
-N3 .Internal mammary
.3
.3 - M - M1 .
, , , , .
Staging- Staging .
US/ .
. , Staging- .
Metastases
M0
M0
M0
M0
M0
M0
M0
M1

Nodes
N0
N0
N0
N1
N2
any
N3
any

Tumor
Tis
T1
T3
T2
T3
T4
any
any

Stage
0
I
II
III
IV

:
Radical mastectomy ) "
.1
( . ,
)" ( .
. .Muscle flaps -
" , .
- , .
Modified radical mastectomy 70- ,
.2
,
. ,Level I - .Level I and level II
'
.
, .MRM
T3 , .

) Wide local excision Partial mastectomy, Segmentectomy,

.3
(Lumpectomy Quadrantectomy .

62

Y.B

, 1-2"
.

) (.
MRM.

) Staging( .
) (SLNB
. ,
;
.MRM
,
.
; - .
C/I :
) 4" ( ,
.1
.
2 )
.2
( .
.
.3
- ,
.4
)( , , ,
) (.
.4 - .
.
':
- SERM-
. . ,
- .
- .
.
HER2 30%- ;
) ( .
' , /
. ' ,
) ( . )
(70 . '
) (.
' , Stage -.
:
) ( :
.1 T3.T4-
.2 .
.3 .
.4 .Internal mammary
.5 / .
.6 8- .

63
.7 .

Y.B