1. بسم الله الرحمن الرحيم
”وقل رب زدنى علما “

2. DR IMRANA AZIZ Assistant Professor Surgical Department

3. CYSTS & ULCERS

4. CYSTS Cyst is a fluid filled sac bound by a wall.
Fluid is often clear, colorless or cholesterol crystals, or tooth paste like.
True Cyst: lined with epithelial or endothelial cells.
False Cyst: which are walled off fluid collection not by epithelium
e.g. Pancreatic pseudocyst

5. Classification
Congenital
Acquired

6. CONGENITAL CYSTS Sequestration dermoid Tubuloembryonic
Cysts of embryonic remnants
Hydatid of Morgagni
Cysts of the urachus
Cyst of vitellointestinal duct
Cysts of wolffian duct
Branchial Cyst
Thyroglossal Cyst

7. ACQUIRED CYSTS Retention cysts Cystic tumours Implantation dermoids
Traumatic cysts
Degeneration
Parasitic cysts
Hydatid,
trichniasis,
cysticercosis

8. Sequestration dermoid:
This is due to dermal cell being buried along to the lines of closure of embryonic clefts and sinuses by skin fusion.
Lined by epidermis and containing paste like material.
Sites midline of body
outer canthus
anterior triangle of mouth.

9. Tubuloembryonic cyst:
in the track of ectodermal tube development.
e.g: thyroglossal cyst, ependymal cyst.

10. Acquired cyst:
Retention cyst:
due to accumulation of secretion in gland behind an obstruction of a duct.
e.g: sebaceous cyst, Pseudu pancreatic cyst, parotid gland cyst.

11. Distension cyst:
occur in thyroid from dilatation of acni.
cystic hygroma and lymphatic cyst.

12. Exudation Cyst
Exudative fluid accumulate in endothelium lined anatomical space.
e.g: Hydrocele, bursa.

13. Cystic tumor Implantation dermoid e.g: cystic teratoma, cystadenoma.
Squamous epithelium driven beneath skin by penetrating wound.

14. Clinical Features Varies according to the site & size
Pain → enlarging cysts,
Pain → Secondary to haemorrhage, infection, rupture, torsion
Acute abdominal emergency: torsion or rupture of ovarian cyst

15. Clinical Features
Compression symptoms resulting from compression of adjacent structures
Haemorrhage in thyroglossal cyst → increase in size → compress the trachea
Large ovarian cyst → abd: fullness & reduced appetite resulting from raises I/abd: pressure
Obstruction to pelvic veins → varicose veins of lower limbs

16. COMPLICATIONS Infection Haemorrhage Torsion Obstruction Calcification
Malignancy ( very rarely)

17. INVESTIGATIONS
Signs: Fluctuant, transilluminant if containing clear fluid
Diagnosis: obvious in cases of superficial cysts
Deep seated intra-abdominal or thoracic cysts need U/sound, CT scan, MRI

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24. ULCER An ulcer is a break in the continuity of an epithelial surface.
Characterized by progressive destruction of the surface epithelium and a granulating base which may clean, healthy or containing necrotic slough

25. Clinical Examination Size Shape Edge Floor Base Discharge
Surrounding area
Lymph nodes
Pain
General exam:
Pathological exam:

28. Marjolin’s ulcer
Malignant change occurring in any long standing benign ulcer irrespective of its cause.
Change usually occurs at the edge of a chronic ulcer

29. Management Treatment of cause Accurate assessment of the ulcer
Identify & correct the co - morbid factors
Adequate drainage & desloughing
Antiseptics and topical antibiotics
Wound dressings
Hydrogel
Alginates
Lyofoam
Tegaderm
Alleyvn

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34. SINUSES
A sinus is a blind tract usually lined with granulation tissue that leads from an epithelial surface into the surrounding tissue.
e.g. pilonidal sinus

35. FISTULA
It is a communicating track between two epithelial surfaces, commonly between a hollow viscus and the skin ( external fistula) or between two hollow viscera ( internal fistula)
The track is lined with granulation tissue which is subsequently epithelialzed

37. CLASSIFICATION
Congenital
Acquired

38. Pathological sinuses ACQUIRED 1. Pilonidal 2. Suture 3. Post-surgical
CONGENITAL
1. Preauricular
2. Umbilical
3. Urachal
4. Coccygeal
5. Sacral
ACQUIRED
1. Pilonidal
2. Suture
3. Post-surgical
4. Actinomycosis
5. Tuberculosis
6. Osteomyelitis

39. Persistence of a sinus or fistula
F Foreign Body & Necrotic Tissue
R Radiation
I Immunosupression
Infection
Ischemia
E Epithelization
N Neoplasia
D Drugs (eg: Steroids , Cytotoxic drugs)
Distal Obstruction
S Systemic Diseases (eg: AIDS)

40. Clinical features Asymptomatic Recurrent or persistent discharge Pain
Infection

41. Diagnosis
Assess the accurate direction, depth & presence of multiple tracts.
Microbiological examination of discharge ( gut organism, actinomycosis, tuberculosis)
Sinogram

42. Management of Sinus Complete excision of all sinus tract.
Sinus is laid open or excised
Biopsy of tissue is sent
Removal of the cause