NBE CME programme for DNB consultants - National Board Of ...

NBE CME programme for DNB consultantsLiver dependent clotting factors; Reason of deranged PT in jaundice, how to correct it; When PT notcorrected by vitamin K injection – reason.Radio Imaging - What are imaging test done to arrive at diagnosis in chronology, screening tests;Benefits of MRCP over ERCP; Indication & limitations of USG abdomen, CECT, ERCP, MRCP.Differential Diagnosis - How to differentiate surgical from non surgical jaundice; Common causesof obstructive jaundice in chronology.Treatment- Cholelithiasis with CBD stone-Different options are Open choledochotomy &cholecystectomy; ERCP removal of stone followed by lap / opne cholecystectomy; Gold standardfor gall stones; Steps of open cholecystectomy with DO’s & DONOT’s; Anatomy & anomalies ofbiliary tract; During Cholecystectomy what to do in case of Bile duct injury; Hepatic artery injury; Whydo remove CBD stone before cholecystectomy.CBE stone alone-Non Surgical treatment(How to prevent & treat cholangitis, Hepatorenal syndrome;Correct fluid & electrolyte imbalance; Correct cogulopathy & treat sepsis; When to stop conservativetreatment & go for surgery.Surgical treatment– Choledochotomy(Method & Interpretation of POCG; Absolute & relativeindications of choledochotomy; Steps of choledochotomy; What to do if stone is impacted at lowerend of CBD; Role of transduodenal sphincterotomy), Choledochoduodenostomy (Methods,indications & contraindications, pre-requisite; Why not preferred in young patients.)ERCP removal & sphincterotomy-Suitable candidates; Technique & difficulties; Contradictions &complications.Residual CBD Stone - With T tube(Burnhenn’s technique; Different treatment options), Without Ttube (Plan of action)Carcinoma head of parncreas- History & Clinical Examination same; Triad of palpable gall bladder,weight loss & jaundice; Stool for occult blood; Benefits of CT over USG abdomen; How to confirmin periampullary carcinoma; Most useful investigation in suspected Ca head pancreas; Differenceof pectability & operabilityWhen curative / palliative; Criteria for declaring inoperable; Guidelines for preoperative confirmationof diagnosis, Gross? Frozen section?; Different palliative procedures & steps of roux en Y; Basicsteps of Whipple’s; Current data related morbidity, mortality & survival benefits of Whipple”sFor better performanceHistory & clinical examination - The student should know the relevance of all positive and negativehistory & be able to express only relevant things, When to ask leading questions.Investigations - Gold standard for gall stone, CBD stone & Ca head of pancreas; Fallacies &short comings of different imaging investigations; Benefits of one over the other; Out of severalinvestigations arts of ordering useful investigation only/Treatment - Treatment plan (ideal in each case); Feasibility n give set up; Criteria of operability,respectability; Basic steps of operation should be very clear to satisfy perform the procedure;Care of T tube; T-tube cholangiogram & interpretation; Should have knowledge of complications &their management; Idea of difficult situation like Mirrizzi”s syndrome, anomalous hepatobiliary; teeBismuth classification of bile duct injury & management; Post cholecystectomy syndrome; WaltmanwalkersyndromeHepato splenomegaly - History (prolonged / unexplained fever; early fatigability , easy bruisability, prolonged bleeding from minor wounds; Yellow discoloration of skin , sclera; Pain abdomen;Haemetemesis; Symptoms due to mass effect specially very large spleen; Lump abdomen.Clinical examination - On general physical exam – look for altered mental status (end stage liverdisease); Pallor, icterus, Ecchymotic patches, lymphadenopathy, pedal oedema, clubbing; Localexam (abdomen) – Dilated veins (with direction of flow in them); Contour of abdomen – ascitis92